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CMS Pushes Effort to Curb Medicare Fraud

Posted on Monday, October 28, 2019 12:20 PM

CMS Administrator Seema Verma wrote in a blog last week that CMS is launching a five-part campaign to stop and punish waste, fraud and abuse in Medicare programs.

“Medicare’s transformation has raised the stakes of program integrity to historically high levels—taxpayers have more to lose than ever before from those who would, whether by negligence or intent, improperly seek payment from our programs,” wrote, Ms. Verma. “They necessitate a paradigm shift in how we approach program integrity.”

The five-part campaign is as follows:

  1. Prosecute fraud. CMS will work with law enforcement to quickly identify and prosecute fraud.
  2. Fraud prevention. CMS will identify high-risk areas and adjust policy to stop fraud before it even starts. After fraud is discovered, CMS will make changes to ensure it is not repeated.
  3. Mitigate “new and emerging” risks. Verma likened fraud prevention to a game of “whack-a-mole,” where new threats arise once old ones are stamped down. CMS regards prior authorization and value-based models in Medicare Advantage as tools to address potential fraudulent behavior.
  4. Ease provider burdens. Reducing administrative and regulatory red tape will reduce clerical errors and make it easier for providers to do their jobs.
  5. Exploit new technology. CMS will use new and emerging tech platforms to automate and modernize its program integrity efforts.

Source: NAHC Report

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