CMS doubles up on savings

Wednesday, June 25, 2014

BALTIMORE – CMS’s Fraud Prevention System (FPS) prevented more than $210 million in improper Medicare payments in its second year of operations, more than double the previous year, according to a report sent to Congress today.

The FPS, which uses predictive modeling and other analytics to analyze billing patterns, also resulted in CMS taking action against 938 providers.

“CMS is using the best of private sector technology to move beyond the ‘pay-and-chase’ approach to protect the Medicare Trust Funds,” stated CMS Administrator Marilyn Tavenner in a press release.

In a report also released today, the Office of Inspector General (OIG) concurred with most of CMS’s findings. It said, however, that the agency could increase savings further by 1.) providing contractors with written instructions on how to determine when savings from an administrative action should be attributed to the FPS and 2.) requiring contractors to maintain documentation to support how FPS information contributes to an administrative action.