The Centers for Medicare and Medicaid Services has saved $2 billion in Medicare claims, thanks to its fraud and abuse initiatives.
CMS’ efforts have been “extremely effective,” said Ted Doyle, director of the Los Angeles satellite division and acting director of the Miami satellite division, of the Program Integrity Group. The initiative has been effective because satellite offices have been able to look at fraud at the local level.
As identified fraud “hot spots,” CMS satellite offices in Los Angeles and Miami will undergo further expansion.
Establishing partnerships and communicating in a different and innovative manner with state government agencies, local law enforcement and commercial insurers who have a presence in the region have been major contributors to CMS’ success, Doyle said. CMS also is collaborating with the private sector, Medicare contractors and medical societies, according to a CMS spokesperson.
For instance, the California Department of Health Services helps in gathering and analyzing state Medicaid and Medicare claims data to identify common problems in both programs.
“In California, CMS, its contractors and state partners have formed a coalition – The California Fraud Coordination Committee – to look at the data globally as it impacts all partners in California,” the spokesperson said. CMS wants to “raise the awareness” of Medicare fraud, waste and abuse, Doyle said. “CMS’ goal is to identify fraud as early and comprehensively as possible and show measurable decreases in fraud,” he said.
While Kip Piper, president of Health Results Group, a Washington-based consulting firm, said CMS has made “significant improvement in the overall capability of looking at fraud, waste and abuse,” the recovery so far is just a small percentage. Piper pointed out that the U.S. Government Accountability Office estimates that 10 percent of healthcare service is fraud and abuse; conservative industry estimates put waste, or incompetence, at 30 percent of all healthcare, he said.