GAO Sees Problems in System To Curb Fraud in Medicare, Medicaid
CMS' systems for detecting fraudulent Medicare and Medicaid claims are "underused" and "inadequate," according to a report released on Tuesday by the Government Accountability Office, the AP/Washington Post reports.
According to the Post, the current $150 million system was launched in 2009 and was intended as "one-stop storage" for CMS staff, law enforcement and state agencies to access Medicare and Medicaid data.
However, the report found the system lacks crucial elements necessary to share systems data to allow analysts to identify and prevent payment of fraudulent claims. Further, plans by CMS to share Medicare and Medicaid data with states and implement new system software have been delayed, the Post reports.
Sen. Tom Carper (D-Del.) said, "To achieve the maximum taxpayer savings, the federal government needs to do a better job of getting this new technology into the hands of oversight staff working to curb the tens of billions of taxpayer dollars lost to waste and fraud." Carper has scheduled a hearing on Tuesday to urge CMS to launch the new system softwareÂ (AP/Washington Post, 7/12).
Medicare Anti-Fraud System Launched
Meanwhile, federal officials this month launched a nationwide anti-fraud system to detect and prevent the payment of inappropriate Medicare claims, the Los Angeles Times reports (Gibson, Los Angeles Times, 7/10). Medicare has awarded an initial $77 million contract for the system.
Pioneered in South Florida, the new "predictive modeling" system will examine Medicare claims daily for signs of fraud, while taking into account warnings from tipsters and a database of suspects.
According to Peter Budetti, who is in charge of Medicare's anti-fraud initiative, the new system focuses on prevention by targeting claims before they are paid. Typically, such investigations are conducted after payment, a method often referred to as "pay and chase."
Budetti said, "We can't prosecute our way out of this," adding, "We have to prevent these bad guys from getting into the program, prevent money from going out the door. And if we do catch them doing stuff, we will turn them over to law enforcement for prosecution" (Los Angeles Times, 7/10).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.