Better anti-fraud efforts are not appeasing lawmakers

Share this article:
Rep. Tim Murphy (R-PA)
Rep. Tim Murphy (R-PA)

Long-term care facilities and other Medicare providers increasingly have seen reimbursements influenced by the government's Fraud Prevention System, an official recently told a Congressional panel. The system prevented or recovered more than $210 million in improper payments during fiscal year 2013, more than doubling the amount from the system's first year, said Shantanu Agrawal, M.D., deputy administrator and director, Center for Program Integrity at the Centers for Medicare & Medicaid Services.

The Fraud Prevention System is designed to analyze billing patterns to flag potentially problematic payments. CMS has taken action against 938 providers and suppliers due to the system, Agrawal said in a June hearing of the House Energy & Commerce Committee's Oversight and Investigations subcommittee.

The improper payment rate increased from 8.5% to 10.7% between 2012 and 2013, but this does not necessarily signal surging criminal activity, Agrawal said. It could indicate providers are struggling to comply with more stringent rules related to payment, which have been implemented by the government to be “very strong on program integrity,” he said. His agency has launched an effort to educate providers “to make sure they are able to follow our rules … our documentation requirements,” he said. It's also working on strengthening disclosure requirements to prevent bad actors from starting a new company under a different name. 

Subcommittee chairman Rep. Tim Murphy (R-PA) criticized the agency.

“The bottom line for taxpayers” is that improper payments total more than the entire Pennsylvania state budget, he said. “So I hope you will improve that.” 


Share this article:
close

Next Article in News

More in News

Bulk of Medicaid to be managed care in two years: Avalere

Bulk of Medicaid to be managed care in ...

More than three-quarters of Medicaid beneficiaries will be enrolled in a managed care plan as of 2016, according to an Avalere Health analysis released Thursday. The numbers reveal that managed ...

Nursing home asked for employee's personal information too often, jury rules

The human resources department of a Maine nursing home did not properly protect a former employee's personal identification information, a jury recently ruled.

Test could confirm sepsis within an hour

Nursing home residents might benefit from a new way of diagnosing and treating sepsis made possible by discoveries out of the University of British Columbia.