CMS: Healthcare reform powers fraud prevention

Tools

Thanks to the Affordable Care Act, the Obama administration has recouped more than $14.9 billion in healthcare fraud recoveries, the Centers for Medicare & Medicaid Services announced yesterday.

Moreover, CMS has thrown 14,663 crooked providers and suppliers out of Medicare over the past two years, compared to only 6,307 revocations two years before healthcare reform screening and review requirements took effect.

Revoked providers had felony convictions, did operate at the address CMS had on file or did not comply with CMS rules.

In addition to stronger provider screening policies, healthcare reform also implemented data-analysis tools to ensure only qualified and legitimate providers and suppliers participate in Medicare, CMS noted.

To further ramp up anti-fraud efforts, the Obama administration redesigned Medicare Summary Notices so beneficiaries can see exactly who has billed Medicare with their identification numbers and better spot potential fraud.

CMS Deputy Administrator for Program Integrity Peter Budetti called the new, easier-to-read summary statements a "landmark change," USA Today reported.

"A beneficiary's best defense against fraud is to check their Medicare Summary Notices for accuracy and to diligently protect their health information for privacy," Budetti said in the announcement.

However, the government's anti-fraud efforts still have room for improvement. A new report by the Office of Inspector General found provider information stored on a pair of Medicare databases was both incomplete and inaccurate.

To learn more:
- here's the CMS announcement
- read the USA Today article

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