Dive Brief:
- A new CMS blog post announced this week has illustrated that efforts to combat fraud and improper payments in Medicare and Medicaid are paying off for taxpayers and beneficiaries.
- The research found that during the two-year period of fiscal years 2013 and 2014 (October 1, 2012 through September 30, 2014) every dollar spent on Medicare program integrity initiatives saved $12.40.
- The report comes on the heels of the largest Medicare fraud sweep in history, which resulted in 301 people being charged with alleged participation in healthcare fraud crimes in late June.
Dive Insight:
The data highlight CMS' increasing success in taking a proactive stance on fighting fraud in recent years, which have marked a turnaround from its earlier "pay-and-chase" strategy.
They also serve as a warning to offenders that "the government is coming," as Healthcare Dive recently reported, and a reminder to the industry that Medicare waste and fraud needs to be reigned in, especially in the face of new projections that Medicare's hospital insurance fund will be depleted by 2028--two years earlier than previously estimated.
CMS' major strategies include ensuring that program providers are properly screened, coordinating CMS' anti-fraud efforts with federal and external partners, and using predictive analytics to prevent fraud, waste, and abuse.
CMS highlighted that for fiscal year 2013, savings from prevention efforts represented 68% of total savings, and that for fiscal year 2014, that number rose to almost 74%. "This development means that more taxpayer dollars intended to care for the beneficiaries are not being paid at all, avoiding the need to recover improperly paid amounts from health care providers and suppliers," the agency noted, adding that preliminary data from fiscal year 2015 suggest the efforts "continue to accrue savings of this magnitude and that the portion attributed to prevention continues to increase."