CMS flaunts fraud savings, revocations

Thursday, June 6, 2013

WASHINGTON – CMS says its anti-fraud efforts in 2011 and 2012 have recovered more than $14.9 billion in healthcare fraud, judgments, settlements and administrative impositions, according to a press release.

A big reason for the agency’s success: new fraud-fighting powers and tools in the Affordable Care Act (ACA).

Since March 2011, when the ACA was signed into law, the agency has revoked the ability of 14,663 providers to bill the Medicare program, compared with 6,307 revocations in the two years prior. Revocations have doubled in 35 states. Those removed from the program had felony convictions, were not operational at the filed address, or were not in compliance with rules, according to the release.

As part of its ongoing efforts to enlist seniors in the fight against fraud, CMS also says it’s redesigning its Medicare Summary Notices, which Administrator Marilyn Tavenner describes as an easier way for seniors to understand the services they’re receiving.

“It’s an important tool for staying informed on benefits, and for spotting potential Medicare fraud by making the claims history easier to review,” she stated.

The updated summary notices are also intended to simplify the process of filing appeals if claims are denied, and to make it easier to identify claims for services that were never received.

In April, CMS announced a proposed rule that would increase up to $9.9 million the rewards paid to Medicare beneficiaries and other parties whose tips lead to successful recoveries of fraudulent claims.