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CMS Fraud Prevention System Expected to Include Areas of Waste and Abuse

Last week CMS announced in the second year of operations, CMS™ Fraud Prevention System identified or prevented $210 million in improper fee-for-service Medicare payments, which more than doubled the previous year™s findings of improper payments. The CMS Fraud Prevention System also resulted in action being taken against 938 providers and suppliers.

The Fraud Prevention System currently focuses on anti-fraud strategy. According to CMS, the Fraud Prevention System uses predictive algorithms and other analytics to analyze billing patterns against every Medicare fee-for-service claim.  The system also uses other data sources including compromised Medicare identification numbers and complaints made through 1-800-MEDICARE. This combination has led to $19.2 billion in fraud recoveries over the previous five years.

The CMS announcement included important details for organizations. According to the announcement, “CMS also expects to expand the use of the Fraud Prevention System beyond the initial focus on identifying potential fraud into the areas of waste and abuse, which will increase future savings.”

With the expected expansion and focus on these programs, it is now more important than ever for organizations to understand healthcare fraud, waste, and abuse laws involving Medicare.

If you have any questions about CMS Fraud, Waste and/or Abuse, please do not hesitate to contact one of our professional consultants.

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