CMS said $42 billion saved through fraud prevention, screening providers

Program integrity efforts within Medicare and Medicaid resulted in about $42 billion in savings in fiscal years 2013 and 2014, according to a new report released by CMS.

In a blog post, Shantanu Agrawal, MD, deputy administrator and director of the CMS Center for Public Integrity, said extra funding aimed at preventing fraud before it occurs and stricter standards for providers paid off, amounting to $12.40 in savings for every dollar put into program integrity.

“CMS’s efforts to proactively prevent potentially fraudulent and improper payments from being made have been increasingly effective, moving our efforts away from the ‘pay-and-chase’ method of recovering payments after they had already been made,” Agrawal wrote. “In fiscal year 2013, savings from prevention activities represented about 68 percent of total savings. In fiscal year 2014, the portion of savings from preventing potentially fraudulent and improper payments rose to nearly 74 percent.  This development means that more taxpayer dollars intended to care for the beneficiaries are not being paid at all, avoiding the need to recover improperly paid amounts from health care providers and suppliers.”

Agrawal said the preliminary data from fiscal year 2015 shows a similar amount of savings from fraud prevention efforts. The complete statistics from that year is expected to be released later in 2015.

Future reports may reflect newer program integrity developments, such as a rule finalized in February requiring Medicare Part and B providers and suppliers to report and return overpayments within 60 days. 

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John Gregory, Senior Writer

John joined TriMed in 2016, focusing on healthcare policy and regulation. After graduating from Columbia College Chicago, he worked at FM News Chicago and Rivet News Radio, and worked on the state government and politics beat for the Illinois Radio Network. Outside of work, you may find him adding to his never-ending graphic novel collection.

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