Medicare, Medicaid Using Anti-Fraud Tool

Application Originally Used for Stimulus Payment Monitoring
Medicare, Medicaid Using Anti-Fraud Tool
The Centers for Medicare & Medicaid Services is the first agency to use a new fraud mapping tool that ultimately will be used throughout the federal government.

The Recovery Accountability and Transparency Board, which monitors distribution of federal funds under the American Recovery and Reinvestment Act, developed the program, which it has been using to guard against improper stimulus payments.

The fraud mapping program "gathers enormous quantities of information in real time and then analyzes the data and helps connect the dots to identify indicators of possible fraud or error," Peter Orszag, director of the Office of Management and Budget, said in a recent blog.

Medicare and Medicaid combined had about $65 billion in improper payments in fiscal 2009, Orszag noted. President Obama has set a goal of cutting the improper payment rate for Medicare in half by 2012.

Also, under the HITECH Act portion of ARRA, CMS will distribute billions in Medicare and Medicaid incentive payments to hospitals and physicians that use qualifying electronic health records systems.

In addition, the White House announced creation of a "Do Not Pay" list, a consolidated database that agencies can use to check the status of a potential contractor or individual to avoid improper payments. The list, for example, will identify contractors no longer eligible for government work.

Orszag offered evidence of why the consolidated list is needed: "Over the past three years, federal auditors have reported that the government paid out benefits totaling more than $180 million to approximately 20,000 Americans who were dead and more than $230 million in benefits to approximately 14,000 fugitive felons or those in jail and not eligible for benefits."

About the Author

Howard Anderson

Howard Anderson

Former News Editor, ISMG

Anderson was news editor of Information Security Media Group and founding editor of HealthcareInfoSecurity and DataBreachToday. He has more than 40 years of journalism experience, with a focus on healthcare information technology issues. Before launching HealthcareInfoSecurity, he served as founding editor of Health Data Management magazine, where he worked for 17 years, and he served in leadership roles at several other healthcare magazines and newspapers.

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