GOP Senators Call for Immediate Release Of CMS Report on Fraud Prevention

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Two Finance Committee senators Oct. 15 sought the immediate release of a statutorily mandated report on the Centers for Medicare & Medicaid Services' fraud prevention system (FPS) that was due Oct. 1.

In a letter to acting CMS Administrator Marilyn Tavenner, Committee ranking member Orrin G. Hatch (R-Utah) and Sen. Tom Coburn (R-Okla.) said: “In the interest of being transparent to taxpayers and stakeholders, and accountable to Congress, we request you publicize the report and reply to our concerns about provider enrollment within three business days.”

Hatch and Coburn said they were concerned the automated provider screening system, which was implemented in December 2011, has not been effective in weeding out fraud among Medicare providers.

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

Section 4241(e) of the Small Business Jobs Act of 2010 required CMS to issue a report on the FPS no later than three months after the program's first year of implementation, which Hatch and Coburn said corresponded with an Oct. 1 deadline.

Hatch and Coburn said they were also concerned that CMS has been sharing data on the FPS with the public but neglecting to keep Congress informed.

“In fact, given the detailed statements by CMS staff in public speeches about the results of the FPS, it seems odd that specific details can be shared in public remarks yet you seek to keep the Congressional committee of jurisdiction in the dark,” the letter said.

Hatch and Coburn cited two examples from BNA's Health Care Fraud Report of CMS briefing the public on FPS information, including a presentation by David Nelson, director of CMS's Data Analytics and Control Group, at a September predictive analytics conference (16 HFRA 689, 9/19/12), and a speech by Peter Budetti, director of CMS's Center for Program Integrity, at America's Health Insurance Plans 2012 Medicare Conference (16 HFRA 752, 10/3/12).

Second Request.

This is the second letter from Hatch and Coburn seeking information from CMS on the FPS, following a July 31 inquiry.

CMS responded on Aug. 27 that it would publish a report for Congress by the end of September (16 HFRA 690, 9/19/12).

“We had initially requested very detailed and specific information answering a number of questions regarding the metrics and costs of FPS and other related initiatives,” the senators said in their Oct. 15 letter. “Instead of a comprehensive response, we received a generic reply that was not truly responsive to our specific questions.”

Hatch and Coburn said they are still troubled by the lack of effective tools to measure the viability of the FPS, and said the delay in receiving the report raises questions about the reliability of CMS data.

CMS did not respond to a request for comment Oct. 15.

By James Swann  

The Hatch/Coburn letter is at

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