Tackle Medicare fraud with data, not 'pay-and-chase,' lawmakers urge CMS

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The Centers for Medicare & Medicaid Services' reported that methods of detecting and preventing healthcare fraud are “not reassuring” as the threat of healthcare fraud continues to grow, House lawmakers said during a hearing Wednesday .

House Ways and Means Oversight Subcommittee Chairman Peter Roskam (R-IL) chastised CMS for its use of “pay-and-chase” methods of investigating healthcare fraud, echoing sentiments expressed by peers in a letter sent earlier this month.

“Despite the fact that Congress has given the agency expanded authority to stop payments before they are made, it continues to rely on pay-and-chase, or making the payment and only checking after the fact to see if it was proper,” Roskam said in his remarks.

Lawmakers praised CMS' fraud detection tools, including the Fraud Prevention System and the predictive analytics program, but pushed the agency to expand its use of data analytics to stop fraudulent activities before they happen.

“[I]f we use better data analysis and predictive analytics — complex data can be used to identify fraud and improper payments faster,” Roskam said. “And that's important not only to save taxpayer dollars, but to save patients who are being harmed by these criminals.”

The hearing also highlighted the partnership between the Department of Health and Human Services' Office of Inspector General and the Department of Justice in combating fraud, including June's massive Medicare fraud bust.