Report Finds Flaws in CMS’ New Fraud Prevention Technology
CMS' newÂ predictive analytics technologyÂ will help the agencyÂ curb fraudulent payments, but the system contains inconsistent data and flawed methodology that prevent the tracking of inaccuracies, according to a report released Monday by HHS' Office of Inspector General, FierceHealthIT reports.
Recent CMS Report
A recent CMS report found that the system has saved the Medicare program about $115 million since it launched.
According to CMS, the system saved Medicare about $32 million by removing fraudulent health care providers from the program and refusing to process suspicious charges. The remaining $84 million in one-year projected savings is expected to come as a result of having fewer fraudulent providers in the program.
Recommendations of OIG Report
The OIG report said that CMS can improveÂ itsÂ new fraud preventionÂ system by:
- Coordinating with law enforcement to better report case outcomes;
- Requiring contractors to track recovered funds (Bird, FierceHealthIT, 12/17/12);
- Revising methodology for calculating projected savings from improper payments to recognize that not all claims from a revoked health care provider are necessarily false and that certain previously denied claims might eventually be paid; and
- Revising methodology for calculating costs avoided to verify certain information and to include costs related to using the system (Clinical Innovation & Technology, 12/17/12).