Lawmakers ask for CMS fraud review

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Two House committees have requested a review of the Centers for Medicare & Medicaid Services' Fraud Prevention System, according to a letter sent to the Government Accountability Office.

Bipartisan leaders on the House Energy and Commerce and House Ways and Means Committees Monday specifically asked the GAO to identify the types of potentially fraudulent payments the FPS found and how many actions have been taken by CMS against providers as a result of the system. The leaders also want to know if the process could be implemented for Medicaid and the Children's Health Insurance Program.

The FPS was implemented in July 2011 by CMS to help identify potentially fraudulent payments in Medicare.

“GAO has previously identified key practices for using predictive analysis systems, including leveraging the results of predictive analysis to address service- or system-specific weaknesses that can lead to payment errors, such as gaps in prepayment edits,” lawmakers wrote.

According to a recent GAO report, thousands of Medicaid beneficiaries and hundreds of providers were involved in potential fraudulent payments during fiscal year 2011. Committee leaders held a hearing June 2 where both the GAO and CMS testified on the issue of waste and fraud in Medicaid.