Wednesday, July 23, 2014

Fraud Prevention Savings Tool Identified Millions in Medicare Savings

Dianne De La Mare

The US Department of Health and Human Services, Office of Inspector General (OIG), has released a report certifying that the HHS’ use of the Fraud Prevention System (FPS) has resulted in $54.2 million in actual and projected savings to the Medicare fee-for-service program and a return on investment of $1.34 for every dollar spent on the FPS. The report also certifies that FPS identified $210.7 million in unadjusted savings. Further, the report finds that on-going use of the FPS will strengthen the government’s efforts to prevent fraud, waste, and abuse in the Medicare fee-for-service program.

HHS’ use of the FPS generated a positive return on investment, and as the department continues to refine its fraud detection models using its governance process and applicable OIG recommendations, it will increase savings. However, the report also indicates that although HHS has made significant progress in addressing the challenges of measuring actual and projected savings, its procedures were not always sufficient to ensure that its contractors provided and maintained reliable data to always support FPS savings.

To help increase savings and improve its reporting on savings measures, OIG recommends:

1) providing contractors with written instructions on how to determine when savings from an administrative action should be attributed to the FPS; and
2) requiring contractors to maintain documentation to support how FPS information contributes to an administrative action.

To obtain a complete copy of the OIG report go to http://go.usa.gov/9ECB.

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