The Centers for Medicare & Medicaid Services should beef up its fraud-fighting efforts with a risk-based antifraud strategy for Medicare and Medicaid, the Government Accountability Office said in December.
In a report citing $95 billion in improper payments paid by the two programs in 2016, the GAO said the healthcare agency is lacking in a fraud-risk assessment and strategy for combating fraud and waste. CMS’s anti-fraud initiatives also only “partially align” with the GAO’s fraud risk framework, the report notes.
“By developing a fraud risk assessment and using that assessment to create an antifraud strategy and evaluation approach, CMS could better ensure that it is addressing the full portfolio of risks and strategically targeting the most significant fraud risks facing Medicare and Medicaid,” the watchdog office said.
The report also criticized CMS for giving some stakeholders, such as providers, anti-fraud training but not doing the same for its own employees. In response, the Department of Health and Human Services said it plans to develop risk-based strategies for both programs, following completing of an ongoing fraud-risk assessment of the federal healthcare marketplace.