CMS: Fraud prevention efforts saved Medicare, Medicaid $42 billion

The Centers for Medicare & Medicaid Services' fraud prevention efforts saved the agency $42 billion dollars in fiscal years 2013 and 2014.

That amounts to $12.40 for every dollar invested in the agency's Medicare fraud, waste and abuse programs, Shantanu Agrawal, M.D. deputy administrator and director for the CMS Center for Program Integrity said in a blog post published Wednesday,

Those savings were largely made through efforts to prevent improper payments, as opposed to the traditional “pay-and-chase” method of recovering payments after they had already been made, Agrawal said. Prevention activities accounted for 68% of the agency's total savings in 2013, rising to nearly 74% in 2014. That percent is estimated to grow again in 2015 according to preliminary data.

The largest amounts of overpayments between FY 2013 and FY 2014 were found in nursing homes, along with inpatient care, outpatient care, physician services and home health, the CMS report notes. The most common area for underpayments were the long-term care and inpatient care sectors.

Agrawal's post also highlighted CMS' use of enrollment screenings, predictive analytics and collaboration with contractors, state Medicaid agencies and law enforcement in identifying potentially fraudulent and improper payments.

“These savings represent funds that remain available to provide needed healthcare to Medicare, Medicaid and Children's Health Insurance Program beneficiaries nationwide and reflect the increasing success of CMS' efforts to proactively prevent improper payments,” Agrawal said.