CMS ramps up Medicare fraud, abuse prevention

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The Centers for Medicare & Medicaid Services on Monday announced new efforts to help reduce fraud, waste and abuse in theMedicare system.

As part of the crackdown, CMS will be morestringent in its oversight of the durable medical equipment supply industry, the agency said.Random visits to suppliers will help the agency ensure that suppliers areactually in business. Other steps: CMS will also call on high-risk beneficiaries to makecertain they are receiving the equipment they need, and for which Medicare isbeing billed. And CMS will be implementing a national Recovery AuditContractor (RAC) program to check for overpayments on Medicare Part A and PartB claims. A six-state, three-year RAC demonstration project yielded $900 million in recoveredoverpayments and discovered $38 million in underpayments to providers. 

Additionally, CMS is consolidating the work of Medicare'sprogram safeguard contractors, and the Medicare Drug IntegrityContractors with new Zone Program Integrity Contractors. Thenew contractors will eventually be responsible for ensuring the integrity ofall Medicare-related claims under Parts A, B, C and D.

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