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Improper Medicaid payments lowered from 14% to 3%

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(The Center Square) — Though payment errors for Medicaid and CHIP can add up to tens of billions of dollars every year, the situation is getting better in Pennsylvania.

The Shapiro administration announced a “significant improvement” in the state’s payment errors, with improper payments dropping compared to the last review in 2019 and coming well-below the national average.

Improper Medicaid payments dropped from 14.2% to 2.5% and the Children’s Health Insurance Program errors dropped from 20.7% to 5.6%.

Both figures do better than the national average of 8.9% and 12.8% for Medicaid and CHIP, respectively.

“All Pennsylvanians deserve access to high-quality, affordable health care, especially those who receive Medicaid and CHIP, including older adults, people with disabilities, children, and families with low incomes,” Department of Human Services Secretary Val Arkoosh said in a press release. “I am proud of DHS’ dedication to lowering the error rate, and our staff who make sure that Medicaid and CHIP are operating with financial integrity so that we can continue to serve those who rely on these programs for their health and well-being.”

The decline in error rates is partially a result of federal-level changes that added eligibility determinations during reviews, DHS Press Secretary Brandon Cwalina said. The Shapiro administration also added monthly case record reviews to improve payments.

“DHS is committed to being a responsible steward of public funds so programs like Medicaid and CHIP can continue to be the lifeline they are to so many,” Cwalina said.

Improper payments include a lack of paperwork as well as potential over- or underpayments: the number indicates issues of accountability, not necessarily fraudulent payments.

Nationally, the Centers for Medicare and Medicaid Services estimated that improper Medicaid payments totaled more than $50 billion in 2023, the lowest cost since 2018; improper payments spiked during the pandemic, hitting almost $99 billion in 2021. CHIP improper payments were significantly less, slightly more than $2 billion.

Federal oversight has criticized some states for failing to establish a paper trail for Medicaid payments; a 2022 audit faulted contract language for Medicaid agreements that didn’t require contractors to keep documents to verify payments were made in line with the law.

A federal Health and Human Services report blamed “insufficient documentation” more than anything else for problems in verifying Medicaid and CHIP payments.

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