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Wednesday, August 22nd, 2012
CMS Launches New Tools to Fight Health Care Fraud

The federal government’s war on healthcare fraud is going high-tech with the opening of a $3.6 million command center.  The Centers for Medicare and Medicaid Services (CMS) pays $750 billion each year to more than 1.5 million healthcare providers, and healthcare fraud is estimated to cost taxpayers more than $60 billion annually (see Health Law Gives Medicare Fraud Fighters New Weapons).  The government’s new anti-fraud computer system aims to adapt tools used by credit card companies to detect suspicious purchases.  Peter Budetti, who oversees anti-fraud efforts at CMS, gives his insight on the new command center:

The new Command Center is bringing together Medicare and Medicaid officials, as well as law enforcement partners from the HHS Office of the Inspector General, the Federal Bureau of Investigation, and CMS’s anti-fraud investigators. The Command Center will gather experts from all different areas – clinicians, data analysts, fraud investigators, and policy experts – into the same room to build and improve our sophisticated new predictive analytics that spot fraud, and to then move quickly on a lead, once potential fraud is identified. The technology also allows us to connect with field offices to track down leads in real time.

The result is that investigations that used to take days and weeks can now be done in a matter of hours. And this new technology can help detect and prevent potential problems and payments. That can mean millions of taxpayer dollars staying out of the hands of fraudsters.

At the end of next month, CMS is expected to report to Congress the number of new scams detected by the anti-fraud computer system.  In the meantime, CMS is already seeing results.  The government has recovered over $4 billion in fraudulent payments this year, which is a record number.   

So now is a good time for healthcare providers to conduct their self audits and to review their systems; the enforcement mechanisms are only getting more powerful and sophisticated.

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