CMS Launched New Initiative to Safeguard Integrity of Medicare and Medicaid
The Centers for Medicare and Medicaid Services (CMS) announced on August 27 a new initiative to strengthen and expand its efforts to ward off fraud and abuse in Medicare and Medicaid and further reduce improper payments made by those programs.
The new initiative builds on existing program integrity efforts by focusing more closely on analysis of claims data to detect improper payments and expose program vulnerabilities.
As part of the initiative, CMS is expanding the Medicare-Medicaid match program where claims data from both programs is analyzed together to detect patterns that may not be evident when billings for either program are viewed in isolation. As a result of combining the data, CMS can identify previously undetected patterns, such as “time bandits,” providers who bill for a total of more than 24 hours in a day in both programs. This project allows CMS to identify vulnerabilities in both programs and work with the states, where appropriate, to take action to protect the Federal share of Medicaid dollars.
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