The term “fraud” often gets used as a catch-all when discussing issues with Medicaid or NEMT billing — but in reality, many of the flagged issues aren’t fraud at all. Instead, they may fall into a category known as improper payments.
Improper payments are payments that should not have been made, or were made in the wrong amount. Unlike fraud — which involves intentional deception — improper payments are usually the result of administrative errors, missing documentation, or eligibility mismatches. Common examples include overpayments, duplicate claims, or billing without the required paperwork.
According to CMS, more than 79% of improper Medicaid payments in 2024 were due to insufficient or missing documentation — not fraud. In fact, many of these payments may have been valid had the appropriate documentation been submitted. Notably, CMS reported that in FY2024, the Medicaid improper payment rate dropped to its lowest level since the pandemic, further underscoring that most errors are process-related, not intentional abuse.
Key Takeaway: While all fraudulent payments are considered improper, not all improper payments are due to fraud.
Check out our webinar for this and lots more insight into FWA, audits, and how to safeguard your NEMT operation below.
How can Move AI protect your NEMT business from fraud, waste, abuse, and improper payments?
- Trip verification and GPS tracking ensure that pickups happen where and when they should.
- Routing optimization helps reduce waste, unnecessary mileage, and overbilling risks.
- Driver credential tracking flags expired documents or eligibility gaps before they lead to denied trips.
- Audit-ready logs provide clear, consistent records for brokers, payers, or state agencies.
…and much more. Don’t miss out on protecting your NEMT business. Schedule your demo HERE.