Wednesday, August 1, 2012

CMS Injects $Millions Into Anti-Fraud Command Center, But Will It Work?

Fierce Healthcare has;
CMS Injects Millions Into Anti-Fraud Command Center But Will It Work?
August 1, 2012 | By Karen M. Cheung
It's a $3.6 million facility. Equipped with a couple of dozen computer workstations, giant screens and new computerized detection systems, the facility will pull together some of the country's biggest experts in the government's campaign to fight fraud, the Associated Press reported. The problem is that Republicans aren't yet convinced the brand-spanking new facility aimed at curbing waste isn't a colossal waste of money, itself.

The Centers for Medicare & Medicaid Services yesterday announced the Program Integrity Commend Center in Baltimore to what it hopes will speed up anti-fraud efforts.

Senate Finance Committee members are demanding answers, accusing CMS of not being transparent. They wanted more details on the Fraud Prevention System (FPS) program and requested specific data regarding performance metrics, targeting of claims for review and actual program results.

"After our offices saw a live demonstration of the FPS, we have concluded there is a significant disconnect between the rhetorical claims made by the administration and the system's actual current operational status," U.S. Sens Orrin Hatch (R-Utah), Ranking Member of the Senate Finance Committee, and Committee member Tom Coburn (R-Okla.) wrote yesterday in a letter to CMS Acting Administrator Marilyn Tavenner.

Although CMS called the system "mature" and spent $77 million to procure the contract for FPS, Hatch and Coburn said "the number of predictive analytic algorithms, or 'models,' being applied to the live payment stream are underwhelming at best. CMS should have hundreds of models in operation, but instead there is a handful, and even the contract fulfillment only requires a few dozen."

The senators also noted that very few models were specifically designed to target procedures, services or supplies at high risk for fraud.

CMS, however, touted the new facility, which will bring together clinicians, data analysts, fraud investigators and policy experts in one physical space to "build and improve our sophisticated new predictive analytics that spot fraud, and to then move quickly on a lead, once potential fraud is identified," Peter Budetti, CMS deputy administrator and director of the Center for Program Integrity, said in a blog 
post yesterday. That coordination will help authorities move faster on investigations that usually take days or weeks to just hours, according to CMS.

"Our expectation is that this center will pay for itself many times over," Budetti said in the AP article.

Medicare currently loses an estimated $60 billion dollars each year to waste, fraud and abuse.

"This is unacceptable. The hemorrhaging of taxpayer dollars ... is ultimately a virtual invisible tax on taxpayers," Hatch and Coburn said.

Meanwhile, CMS noted it had the largest healthcare fraud busts in history, recovering a record $4 billion this year.

For more information:
- see the CMS blog 
- read the AP 
- here's the Senate Finance 
announcement and letterRelated Articles:
Prepayment audits to start Aug. 27
Providers fear fraud allegations
3 schemes that drained Medicare of millions
Congress questions Medicare audit coordination
CMS fights fraud with predictive modeling
$1.2B recoveries expected with anti-fraud efforts

Thank You Fierce Healthcare and Ms Cheung

It's not the hardware that's at fault.

Medicare Fraud Detection System Disappoints 

"To date, the $77 million computer system, which went online in mid-2011, had prevented exactly one bad claim by late last year. That totaled $7,591."
Obama Taps Dr Seuss To Run CMS

Here's a few articles we've posted, and reposted from better informed sources than ourselves, which we've tagged as CMS.

Does it really take Albert Einstein to figure out the how, or rather, the WHY, a $77 Million Dollar system saved us 1 bad claim of $7,591?

It's not the hardware that's at fault. It's the endemic "you scratch my back and I'll scratch yours" culture our Government has Funded and Fostered for decades. Industry and Government/Public and Private monies Must be separated. 

People working in Government Regulatory/Research/Etc capacities MUST become statutorily prohibited from taking employment/stock/whatever comprising Any monetary gain with or from any of the Private Companies they regulated upon termination of their Government Service.

And the American Psychiatric/Psychological Associations must be given a Congressional Mandate to either Put Up, or Shut Up. Cure Something besides your own Medical Co-Workers, or no more of everyone else's money for you.

This Professional Courtesy Crap, no matter How many levels of ALJ it's washed through, has got to stop. If everybody Else is incurable, So are the Purchasers of Pharma Money Corrupted University Issued work Licenses.

Psychiatry's "Research Must Continue" Horseshit has run its course. America cannot afford anymore of Psychiatry's 'Research is Promising' which in un-psychiatrically-weaponized/ideated English means "How can we make the drug Companies who own us happy by Inventing one specious excuse after another to sell even More of their horrific product.

The financial drain on our SSDI system on top of our Medicare/Medicaid, and Public Employee Payroll to feed all of those Diagnosing Moochers, at their present rate of acceleration, will have us all living in cardboard boxes by next Wednesday if it is not stopped Yesterday.

Sorry to bore you regular readers again with this, but when we have a Major American City billing the BeJeezus out of all 50 States, and it's perfectly OK for 2 of its Billing all 50 States Hospitals and Staffs to NOT Exist:

'Mental Health' in San Francisco: Link Fest

How much more of this "Throw Trillions of Dollars to your Voter Base and look the other way as it disappears" can we survive?

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