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Tuesday, October 16, 2012

Trouble Brewing for Medicare's Predictive Modeling Program

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Two Republicans Senators continued their quest to gather information on CMS's anti-fraud predictive analytics program, sending a letter to the agency this week calling for the delivery of a report on the program by this Thursday.  Sens. Orrin G. Hatch (R-Utah), the Finance Committee's ranking member, and Tom Coburn (R-Okla.), said CMS was statutorily mandated to publish a report on the program by Oct. 1, and said the absence of any performance metrics makes it impossible to judge the success of predictive analytics. The letter cited two articles from BNA's Health Care Fraud Report backing up charges that CMS has shared information on the program with the general public, but not with Congress.

Hatch and Coburn sent a letter to CMS in July, requesting information on the program, and received a response in August that they characterized as being "a generic reply that was not truly responsive to our specific question." The analytics program, also known as the Fraud Prevention System (FPS), was launched July 1, 2011, and uses predictive modeling and data analytics to review all Medicare fee-for-service claims for indications of fraud. CMS is required to issue a report on the FPS no later than three months after the program's first year of implementation, according to Section 4241(e) of the Small Business Jobs Act of 2010. 

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