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Capitol Health Call
June 11, 2014

GAO: CMS Needs to Hit Fraud Harder

JAMA. 2014;311(22):2264. doi:10.1001/jama.2014.6833

The Centers for Medicare & Medicaid Services (CMS) could do more to detect and prevent Medicare fraud, according to an April 30 report from the Government Accountability Office (GAO). In fiscal year 2013, improper payments amounted to almost $50 billion, up $5 billion from the previous year, stated the report (http://1.usa.gov/1mZMlpT).

The CMS has not put into place all the measures to screen physicians, hospitals and other clinicians and institutions authorized by the Affordable Care Act, such as implementing surety bonds and issuing a rule on disclosure requirements to prevent fraudulent clinicians, institutions, and suppliers from participating in Medicare, according to the report. The GAO also recommended that Medicare use automated prepayment edits more widely to deny improper claims and that it strengthen its ability to systematically track and resolve system vulnerabilities that allow for improper payments.