MSA News - Department of Health & Human Services (HHS) Reports To Congress on Progress of Anti-Fraud Efforts
HHS Reports Record Savings To Protect the Medicare Trust Fund from Fraud.
The Centers for Medicare and Medicaid Services (CMS) are using the Fraud Prevention System (FPS) to run predictive algorithms and other sophisticated analytics nationwide against all Medicare fee-for-service (FFS) claims prior to payment. For the first time in the history of the program, CMS is systematically applying advanced analytics against Medicare FFS claims on a streaming, nationwide basisas part of its comprehensive program integrity strategy.
CMS made significant progress using the Medicare fee for service (FFS) to identify action to protect the Medicare Trust Funds. In the second implementation year, which aligned with Fiscal Year 2013, CMS took administrative action against 938 providers and suppliers due to the FPS. The identified savings associated with these prevention and detection actions due to FPS was $210.7 million, almost double the amount identified during the first year of the program. This resulted in more than a $5 to $1 return on investment, an increase from last year's $3 to $1 return.