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%
2021	Cycle 1 - RY 2019 Cycle 2 - RY 2020 Cycle 3 - RY 2021	$98.72	21.69%	13.90%	0.04%	16.62%
2022	Cycle 2 - RY 2020 Cycle 3 - RY 2021 Cycle 1 - RY 2022	$80.57	15.62%	10.42%	0.03%	11.89%
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%
2021	Cycle 1 - RY 2019 Cycle 2 - RY 2020 Cycle 3 - RY 2021	$5.37	31.84%	13.67%	0.48%	28.71%
2022	Cycle 2 - RY 2020 Cycle 3 - RY 2021 Cycle 1 - RY 2022	$4.30	26.75%	11.23%	0.62%	24.01%
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.

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09/06/2023 04:57 PM

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