New program will target fraud in Medicare, Medicaid, officials say

The federal government will soon unveil a new contractor program aimed at fraud in both the Medicare and Medicaid programs, according to an official with the Centers for Medicare & Medicaid Services.

The new Unified Program Integrity Contractor program will help detect and prevent fraud in both programs, Shantanu Agrawal, M.D., deputy administrator and director of the Center for Program Integrity at CMS, told Bloomberg BNA. Vendors are currently vying for contractor slots in the program, Agrawal added.

The new program will take the place of both Zone Program Integrity Contractors, which identify and investigate Medicare fraud, and Medicaid Integrity Contractors.

“By combining the two programs, we hope to close the gaps between Medicare and Medicaid,” Agrawal told Bloomberg BNA.

Additionally, CMS is slated to introduce a new predictive analytics program created to stop improper payments before they're made. That program will focus solely on Medicare for the foreseeable future, since real-time Medicaid claims data is harder to obtain, Agrawal noted.