TABLE 1


Estimated Amount of Improper Payments
(By Type of Error)
Type of Improper Payment Estimated Dollars In Improper Payments (in millions) Improper Payments as a Percent of Total
Documentation: $10,846 46.76
Insufficient Documentation 7,596 32.75
No Documentation 3,250 14.01
Lack of Medical Necessity 8,529 36.78
Incorrect Coding 1,97 88.53
Noncovered or Unallowable Services 1,219 5.26
Other 620 2.67
Total $23,192 100.00


















TABLE 2


Estimated Amount of Improper Payments
By Type of Error/Provider
Type of Provider Types of Error (in millions) Total Percentage of Improper Payments
Insufficent/No Documentation Lack of Medical Necessity Incorrect Coding Noncovered/Unallowable Service Remaining Errors
Inpatient PPS $1,040 $3,301 $900 ($2) $5,239 22.59
Physician 2,756 614 1,070 $329 258 5,027 21.68
Home Health Agency 1,684 1,935 31 3,650 15.74
Outpatient 2,286 356 1 85 82 2,810 12.12
Skilled Nursing Facility 1,056 1,365 3 2,424 10.45
Laboratory 1,173 146 (14) 30 2 1,337 5.76
Subtotal $9,995 $7,717 $1,957 $444 $374 $20,487 88.34
Other Providers 851 812 21 775 246 2,705 11.66
Total $10,846 $8,529 $1,978 $1,219 $620 $23,192 100.00
Percentage of Improper Payments 46.76 36.78 8.53 5.26 2.67 100