Fraud prevention efforts save CMS $42B in two years


A layered approach to fraud prevention saved the Centers for Medicare and Medicaid Service billions of dollars over a two year period, according to a CMS blog post that attributed the savings to predictive analytics and enhanced enrollment screening.

CMS saved more than $12 for every dollar spent on initiatives to prevent fraud and improper payments within the Medicare program, contributing to $42 billion in savings in both Medicare and Medicaid during fiscal years 2013 and 2014. In FY13, fraud prevention activities accounted for 68 percent of total savings within CMS; in FY14, that increased to 74 percent.

“Preliminary information from FY 2015 indicates that CMS’s program integrity efforts continue to accrue savings of this magnitude and that the portion attributed to prevention continues to increase,” Deputy Administrator and Director for the Center for Program Integrity Shantanu Agrawal, M.D., wrote in the blog post.

The $42 billion figure represents all of the agency’s preventatives efforts, including provider enrollment and screening standards, increased fraud enforcement and predictive analytics. In May, CMS reported that the federal government’s Fraud Prevention System saved $1 billion over the last two years, contributing to $1.5 billion since the analytics system was implemented in 2011.

For the last two years, CMS has been strengthening its ability to deny or revoke Medicare enrollment to bad actors with ties to healthcare fraud. Earlier this year, CMS announced it would be using enhanced provider screening software and additional site visits to improve provider enrollment screening, an issue that has left the program open to nearly $90 billion in improper payments in 2015.