government

Senators press CMS for fraud prevention statistics

NEWS IN BRIEF — Posted Oct. 29, 2012

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Senate Republicans have asked the Obama administration to release a report on efforts to prevent fraud in Medicare.

The Centers for Medicare & Medicaid Services missed an Oct. 1 statutory deadline to publish actual and projected savings through the use of predictive analytics, which involves monitoring Medicare claims in real time for aberrant billing patterns that could indicate fraud. The report was a requirement of the Small Business Jobs Act of 2010.

“We were disappointed that we did not receive the report,” wrote Sens. Tom Coburn, MD (R, Okla.), and Orrin Hatch (R, Utah). “Instead, all our office received in response to staff inquiries about the status of the report was an email stating that CMS was ‘working diligently to finalize our report, which will detail the government’s pioneer efforts in using advanced predictive analytics to identify and fight fraud.’ ”

Information about the new anti-fraud system has leaked through media reports, the senators stated. For instance, CMS apparently has performed licensure checks on 800,000 physicians and completed enrollment screens on all 1.5 million health professionals to determine fraud risk to Medicare. However, fraud still frequently occurs, and Dr. Coburn and Hatch said they want to evaluate the effectiveness of new screening measures.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2012/10/29/gvbf1029.htm.

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