While everyone in Washington is committed to stopping Medicare fraud, it seems not everyone is on the same page about how to do it. A recent letter from some senior Republicans questioned whether the Centers for Medicare & Medicaid Services is taking full advantage of predictive analytics to stop improper payments from going out the door in the first place.
Republicans raised concerns that CMS is still stuck in a “pay and chase” model, tracking down improper payments after they’ve been made. While the CMS Fraud Prevention System is designed to use predictive analytics and data analysis to stop improper payments from ever being made, Republicans said they’re concerned it’s not being used properly.
The FPS was rolled out in 2011 and was responsible for $133 million in adjusted savings in 2014, according to the most recent certification of the program by the Health and Human Services Office of Inspector General.
Arnold & Porter’s Kirk Ogrosky told me that most of the Department of Justice’s fraud cases over the last five years have been the result of pay and chase methods, not predictive analytics. “While there is no question that CMS and DOJ are getting better, it appears to be a slow-moving, bureaucratically burdened train,” Ogrosky told me.
The Republicans’ letter asked for a list of all the Medicare fraud schemes that have been referred to Zone Program Integrity Contractors (ZPICs) by the FPS for further investigation, as well as how many total investigations ZPICs have conducted over the past three years. Responses were requested by Sept. 26.
Stay on top of new developments in health law and regulation with a free trial to the Health Law Resource Center.
Learn more about Bloomberg Law and sign up for a free trial.
All Bloomberg BNA treatises are available on standing order, which ensures you will always receive the most current edition of the book or supplement of the title you have ordered from Bloomberg BNA’s book division. As soon as a new supplement or edition is published (usually annually) for a title you’ve previously purchased and requested to be placed on standing order, we’ll ship it to you to review for 30 days without any obligation. During this period, you can either (a) honor the invoice and receive a 5% discount (in addition to any other discounts you may qualify for) off the then-current price of the update, plus shipping and handling or (b) return the book(s), in which case, your invoice will be cancelled upon receipt of the book(s). Call us for a prepaid UPS label for your return. It’s as simple and easy as that. Most importantly, standing orders mean you will never have to worry about the timeliness of the information you’re relying on. And, you may discontinue standing orders at any time by contacting us at 1.800.960.1220 or by sending an email to firstname.lastname@example.org.
Put me on standing order at a 5% discount off list price of all future updates, in addition to any other discounts I may quality for. (Returnable within 30 days.)
Notify me when updates are available (No standing order will be created).
This Bloomberg BNA report is available on standing order, which ensures you will all receive the latest edition. This report is updated annually and we will send you the latest edition once it has been published. By signing up for standing order you will never have to worry about the timeliness of the information you need. And, you may discontinue standing orders at any time by contacting us at 1.800.372.1033, option 5, or by sending us an email to email@example.com.
Put me on standing order
Notify me when new releases are available (no standing order will be created)