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Comprehensive Error Rate Testing (CERT)

The Centers for Medicare & Medicaid Services (CMS) calculates the Medicare Fee-for-Service (FFS) improper payment rate through the Comprehensive Error Rate Testing (CERT) program. Each year, CERT evaluates a statistically valid random sample of claims to determine if they were paid properly under Medicare coverage, coding, and billing rules.

The fiscal year (FY) 2015 Medicare FFS program improper payment rate is 12.1 percent, representing $43.3 billion in improper payments, compared to the FY 2014 improper payment rate of 12.7 percent or $45.8 billion in improper payments (1). The table below outlines the improper payment rate and projected improper payment amount by claim type for FY 2015. The reporting period for this improper payment rate is July 1, 2013 -June 30, 2014.

Service Type Improper Payment Rate Improper Payment Amount (2)
Inpatient Hospitals 6.2% $7.0B
Durable Medical Equipment 39.9% $3.2B
Physician/Lab/Ambulance 12.7% $11.5B
Non-Inpatient Hospital Facilities 14.7% $21.7B
Overall 12.1% $43.3B

All public reports produced by the CERT program are available through the "CERT Reports" link on the section navigation tray to the left. The improper payment rate is released annually in the HHS AFR in the “Other Accompanying Information” section, which can be accessed through the HHS AFR link in the Related Links section at the bottom of this page.

(1) The national overall and inpatient hospital improper payment rates are adjusted for the impact of Part A to B rebilling of denied inpatient claims.  

(2) Columns may not sum correctly due to rounding.