CMS: Fraud prevention system saves $820M in improper Medicare payments

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The Centers for Medicare & Medicaid Services Fraud Prevention System identified or prevented $820 million in improper payments in its first three years, the agency announced in a report.

CMS said that in 2014 the system identified $454 million in inappropriate payments, resulting in administrative actions against 2,000 providers. Providers targeted by the FPS could have billing privileges revoked or be referred to law enforcement, among other consequences, according to the CMS report. The FPS was first implemented in 2011, after being created by the Small Business Jobs Act in 2010.

CMS officials said they plan to expand the FPS to identify early leads for intervention by Medicare Administrative Contractors. In the future, the FPS could also be used to “stop claims to allow for medical review by the Recovery Audit Contractors prior to payment,” the CMS report states.

The FPS, which uses predictive analytics to identify fraud, played a major role in last month's massive Medicare fraud sweep, which saw 243 individuals charged with conspiring to submit $712 million in false billings.