PERM Error Rate Findings and Reports

Welcome to the PERM reports and reference documents page.  This page houses various reports and reference documents associated with the PERM program.

 

Rolling National Medicaid Improper Payment Rates

Year

PERM Cycles Included

Estimated Improper Payments (in billions)

Overall Rate

FFS Rate

Managed Care Rate

Eligibility Rate

2010

Cycle 2 – FY 2007

Cycle 3 – FY 2008

Cycle 1 – FY 2009

$22.5

9.4%

4.4%

1.0%

5.9%

2011

Cycle 3 – FY 2008

Cycle 1 – FY 2009

Cycle 2 – FY 2010

$21.9

8.1%

2.7%

0.3%

6.0%

2012

Cycle 1 – FY 2009

Cycle 2 – FY 2010

Cycle 3 – FY 2011

$19.2

7.1%

3.0%

0.3%

4.9%

2013

Cycle 2 – FY 2010

Cycle 3 – FY 2011

Cycle 1 – FY 2012

$14.4

5.8%

3.6%

0.3%

3.3%

2014

Cycle 3 – FY 2011

Cycle 1 – FY 2012

Cycle 2 – FY 2013

$17.5

6.7%

5.1%

0.2%

3.1%

2015

Cycle 1 – FY 2012

Cycle 2 – FY 2013

Cycle 3 – FY 2014

$29.12

9.78%

10.59%

0.12%

3.11%

2016

Cycle 2 – FY 2013

Cycle 3 – FY 2014

Cycle 1 – FY 2015

$36.25

10.48%

12.42%

0.25%

3.11%

2017

Cycle 3 – FY 2014

Cycle 1 – FY 2015

Cycle 2 – FY 2016

$36.73

10.10%

12.87%

0.30%

3.11%

2018

Cycle 1 – FY 2015

Cycle 2 – FY 2016

Cycle 3 – FY 2017

$36.25

9.79%

14.31%

0.22%

3.11%

2019

Cycle 2 – FY 2016

Cycle 3 – FY 2017

Cycle 1 – RY 2019

$57.36

14.90%

16.30%

0.12%

8.36%

2020

Cycle 3 – FY 2017

Cycle 1 – RY 2019

Cycle 2 – RY 2020

$86.49

21.36%

16.84%

0.06%

14.94%

  • For the 2015-2018 measurements, eligibility reviews were suspended. Rolling eligibility component statistics for 2015-2018 reflect the latest eligibility results from the most recent cycles prior to the eligibility freeze. 2019 represents the first cycle measured under the new PERM regulation (82 FR 31158). Cycles prior to 2015 were measured under the previous PERM eligibility methodology. Additionally, CMS began reporting the official rates to two decimal places in 2015. Cycles prior to 2015 had rates reported to one decimal place.
  • The overall estimate is comprised of the weighted sum of the FFS and managed care components, plus the eligibility component, minus a small adjustment to account for the overlap between the claims and eligibility review functions.

 

 

National Rolling CHIP Improper Payment Rates

Year

PERM Cycles Included

Estimated Improper Payments (in billions)

Overall Rate

FFS Rate

Managed Care Rate

Eligibility Rate

2013

Cycle 3 – FY 2011

Cycle 1 – FY 2012

$0.6

7.1%

5.7%

0.2%

5.1%

2014

Cycle 3 – FY 2011

Cycle 1 – FY 2012

Cycle 2 – FY 2013

$0.6

6.5%

6.2%

0.2%

4.2%

2015

Cycle 1 – FY 2012

Cycle 2 – FY 2013

Cycle 3 – FY 2014

$0.63

6.80%

7.33%

0.37%

4.22%

2016

Cycle 2 – FY 2013

Cycle 3 – FY 2014

Cycle 1 – FY 2015

$0.74

7.99%

10.15%

1.01%

4.22%

2017

Cycle 3 – FY 2014

Cycle 1 – FY 2015

Cycle 2 – FY 2016

$1.24

8.64%

10.29%

1.62%

4.22%

2018

Cycle 1 – FY 2015

Cycle 2 – FY 2016

Cycle 3 – FY 2017

$1.39

8.57%

12.55%

1.24%

4.22%

2019

Cycle 2 – FY 2016

Cycle 3 – FY 2017

Cycle 1 – RY 2019

$2.74

15.83%

13.25%

1.25%

11.78%

2020

Cycle 3 – FY 2017

Cycle 1 – RY 2019

Cycle 2 – RY 2020

$4.78

27.00%

14.15%

0.49%

23.53%

  • For the 2015-2018 measurements, eligibility reviews were suspended. Rolling eligibility component statistics for 2015-2018 reflect the latest eligibility results from the most recent cycles prior to the eligibility freeze. 2019 represents the first cycle measured under the new PERM regulation (82 FR 31158). Cycles prior to 2015 were measured under the previous PERM eligibility methodology. Additionally, CMS began reporting the official rates to two decimal places in 2015. Cycles prior to 2015 had rates reported to one decimal place.
  • The overall estimate is comprised of the weighted sum of the FFS and managed care components, plus the eligibility component, minus a small adjustment to account for the overlap between the claims and eligibility review functions.
Page Last Modified:
01/13/2021 08:14 AM