02/19/2025

$42 Million in Improper Cancer Care Claims: See Where Oncologists Made Mistakes

In November, the Centers for Medicare and Medicaid Services (CMS) released its 2024 Medicare Fee-for-Service Supplemental Improper Payment Data, which included results from the agency’s review of more than 50,000 Medicare claims from July 1, 2022, through June 30, 2023. The agency found an overall improper payment rate of 7.66%, totaling almost $32 billion in improperly paid claims.

Among the most surprising findings were dramatic differences in error rates among the specialties that see patients with cancer:

• Medical oncologists had the lowest error rate among all specialties, with only 0.9% of Part B payments marked as “improper.
• Radiation oncologists logged one of the highest error rates, at 16.9%.
• Hematology-oncology specialists were somewhere in the middle, with a 6.0% error rate.

The CMS report points to where and how many of these errors were made.

Evaluation and Management Services
The 2024 Comprehensive Error Rate Testing (CERT) report indicates that established patient office visits (99211–5) were one area in which hematology-oncology specialists submitted a significant volume of errant claims.

Hematologists-oncologists logged almost $42 million in improper payments for established patient office visits last year, which put them in the top five specialties for errors in this category. Only internal medicine, family practice, nurse practitioners, and ophthalmologists had higher improper payment rates in this category.

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