CMS’ Fraud Prevention System Creates Significant Impact

Fraud, Medicare, Medicare Set-Asides on July 29, 2015 | Posted by Jennifer Alvarez, JD, RN, MSCC, CMSP

The Centers for Medicare & Medicaid Services (CMS) recently recognized and applauded the agency’s internal Fraud Prevention System for the identification or prevention of $820 million in improper payments during the program’s first three years of operation. The focus of the Fraud Prevention System is to help protect Medicare Trust Funds and prevent fraudulent payments through the detection of questionable/aberrant billing patterns and development of leads for investigations and action. The investment payoff for the program has been impressive as noted by CMS Acting Administrator Andy Slavitt, who stated “Very few investments have a 10:1 return on taxpayer money.” Given its success, CMS plans to expand the Fraud Prevention System to identify non-compliant health care providers at lower levels, who are expected to be better served with data transparency interventions or education.

For more information, please see the Report under “Guidance and Reports” at: http://www.cms.gov/About-CMS/Components/CPI/Center-for-program-integrity.html