Medicare fraud prevention : CMS has implemented a predictive analytics system, but needs to define measures to determine Its effectiveness : report to congressional requesters.

Format:

Book

Government document

Author/Creator:

United States. Government Accountability Office

Language:

English

Subjects (All):

Centers for Medicare & Medicaid Services (U.S.)--Rules and practice.

Centers for Medicare & Medicaid Services (U.S.).

Medicare fraud--Prevention.

Medicare fraud.

Medicare--Claims administration--United States.

Medicare.

Letting of contracts--United States--Evaluation.

Letting of contracts.

Medicare--organization & administration.

Medicare--legislation & jurisprudence.

Fraud--prevention & control.

Fraud--legislation & jurisprudence.

United States.

Letting of contracts--Evaluation.

Medicare--Claims administration.

Medical Subjects:

Centers for Medicare & Medicaid Services (U.S.).

Medicare--organization & administration.

Medicare--legislation & jurisprudence.

Fraud--prevention & control.

Fraud--legislation & jurisprudence.

United States.

Genre:

Rules.

Physical Description:

1 online resource (ii, 43 pages) : color illustrations, color map

Other Title:

CMS has implemented a predictive analytics system, but needs to define measures to determine Its effectiveness

Place of Publication:

[Washington, D.C.] : U.S. Govt. Accountability Office, [2012]

Summary:

GAO has designated Medicare as a high-risk program, in part because its complexity makes it particularly vulnerable to fraud. CMS, as the agency within the Department of Health and Human Services (HHS) responsible for administering Medicare and reducing fraud, uses a variety of systems that are intended to identity fraudulent payments. To enhance these efforts, the Small Business Jobs Act of 2010 provided funds for and required CMS to implement predictive analytics technologies--automated systems and tools that can help identify fraudulent claims before they are paid. In turn, CMS developed FPS. GAO was asked to (1) determine the status of the implementation and use of FPS, (2) describe how the agency uses FPS to identify and investigate potentially fraudulent payments, (3) assess how the agency's use of FPS compares to private insurers' and Medicaid programs' practices, and (4) determine the extent to which CMS has defined and measured benefits and performance goals for the system. To do this, GAO reviewed program documentation, held discussions with state Medicaid officials and private insurers, and interviewed CMS officials and contractors.

Notes:

Title from title screen (viewed on Dec. 31, 2012).

"October 2012."

Includes bibliographical references.

"GAO-13-104."

OCLC:

823392572