CMS Efforts to Prevent Fraud Score Billions in Savings

A newly released report by the Centers for Medicare and Medicaid Services (CMS) shows that efforts to prevent fraudulent and improper payments in Medicare and Medicaid successfully saved billions of dollars.

 A report by the Center for Program Integrity (CPI), a group within CMS that promotes the integrity of the Medicare and Medicaid programs by monitoring program vulnerabilities and overseeing all CMS interactions with key stakeholders, stated that a total of $42 billion was saved over a 2-year period (from October 1, 2012 through September 30, 2014) by reducing fraud and improper payments in the Medicare and Medicaid programs.

“Every dollar invested in CMS’ Medicare program integrity efforts saved $12.40 for the Medicare program,” Shantanu Agrawal, MD, deputy administrator and director of CPI, said in the CMS blog.
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Efforts by CPI to reduce fraud and improper payments included making sure health care providers enrolled in Medicare and Medicaid programs are properly screened; using predictive analytics to prevent fraud, waste, and abuse; and being proactive in preventing potential fraudulent or improper payments instead of trying to recover those payments once made.

According to Dr Agrawal, savings from prevention activities have grown over the two years, representing 68% of the savings in fiscal year 2013 and 74% of the savings in 2014. 

“This development means that more taxpayer dollars intended to care for the beneficiaries are not being paid at all, avoiding the need to recover improperly paid amounts from health care providers and suppliers,” Dr Agrawal said.

Although savings for fiscal year 2015 will not be available until later this year, Dr Agrawal said that preliminary data show that the proportion of savings attributed to prevention efforts continues to increase.

In line with its commitment to protect beneficiaries from harm and to safeguard taxpayer money, CMS will continue to evaluate and update its program integrity strategy, said Dr Agrawal.

“We welcome input from beneficiaries, providers, suppliers, and others to inform possible future enhancements to our program integrity strategy,” he said.—Mary Beth Nierengarten