CMS to Issue Report on System to Prevent Fraud by End of September, Tavenner Says

Stay ahead of developments in federal and state health care law, regulation and transactions with timely, expert news and analysis.

The Centers for Medicare & Medicaid Services will publish a report for Congress and the public by the end of September detailing the results of the Fraud Prevention System (FPS), according to a letter to the minority staff of the Senate Finance Committee obtained by BNA Sept. 11.

“This report will include the results of the FPS in the first year, including a detailed breakout of any dollar amounts that have been saved as a direct result of the FPS,” acting CMS Administrator Marilyn Tavenner said in the letter. “As required by law,” she said, “the savings and the methodology for calculating those savings will be certified by” the Department of Health and Human Services Office of Inspector General.

Tavenner's letter was prompted by an inquiry July 31 from Sens. Orrin G. Hatch (R-Utah), ranking member on the Senate Finance Committee, and committee member Tom Coburn (R-Okla.), that sought information on the success level of the FPS program (see related item in the Leading the News section).

In their letter to CMS, Hatch and Coburn asked for detailed information on the anti-fraud program, including the amount of money recovered so far as well as how the agency targets claims for further review. The senators also asked CMS to explain how it evaluates the overall success of the program 16 HFRA 597, 8/8/12).

Julia Lawless, the Senate Finance Committee's Republican press secretary, speaking for Hatch, told BNA Sept. 13 that the CMS response was “yet another dodge and deflect from this administration. American taxpayers deserve to know how this money is being spent and what they are getting for their investment. Senator Hatch will continue to hold the administration accountable and push to have his questions fully answered.”

The FPS program, which was launched July 1, 2011, uses predictive modeling and data analytics to review all Medicare fee-for-service claims--roughly 4.5 million a day--for indications of fraud.

Additional Anti-Fraud Efforts.

In addition to the upcoming report on the FPS program, Tavenner's Aug. 27 letter included information on recent CMS anti-fraud initiatives, including a new command center designed to foster collaboration among CMS, contractors, and law enforcement.

Tavenner said the $3.6 million command center, which was unveiled to the public July 31, “provides a collaborative workspace for CMS staff, contractors and law enforcement partners to better collaborate and leverage several fraud detection and prevention tools, including the FPS and our Automated Provider Screening (APS) system” (16 HFRA 596, 8/8/12).

Tavenner also mentioned an anti-fraud partnership between the public and private sector that was launched July 26 (16 HFRA 596, 8/8/12)(23 MCR 883, 8/3/12).

“While potential goals have been identified, the operational structure of the partnership and the initial work plan are still under development, as well as the use and identity of a third party and any specifics on data sharing,” she said.

By James Swann  

The CMS letter is at

The Hatch/Coburn letter is at

Request Health Care on Bloomberg Law