Dive Brief:
- CMS has announced that its Fraud Prevention System has saved the agency over $210 million in fiscal 2013 by blocking improper Medicare reimbursements.
- CMS' Fraud Prevention System uses a technology known as predictive analytics to compare fee-for-service claims to larger billing patterns, as well as compromised Medicare ID numbers and complaints coming in through the Medicare hotline.
- According to CMS, the system saw to it that the agency doubled the improper payments recovered or blocked, and also caused the agency to initiate action against 938 health providers and suppliers.
Dive Insight:
According to CMS, this approach is far superior to previous fraud prevention efforts, which Administrator Marilyn Tavenner dubbed "pay-and-chase." Still, not everyone is satisfied with the program, which captured only a small fraction of the estimated $50 billion in improper payments made by CMS each year. According to Rep. Tim Murphy (R-PA), "this is a shocking amount of taxpayer money to lose every year." But CMS faces some formidable obstacles in improving its fraud-detection efforts. For example, to remove bogus Medicare numbers, the agency needs to alter 70 different systems in state government and the private sector, an effort that would require additional resources.