$42 Billion CMS Claims Questioned - DoctorsManagement $42 Billion CMS Claims Questioned - DoctorsManagement

$42 Billion CMS Claims Questioned

By Frank Cohen, Director of Analytics and Business Intelligence

As originally published by Racmonitor.com

EDITOR’S NOTE: The Centers for Medicare & Medicaid Services (CMS) recently released a report showing that investments made in program integrity activities resulted in the agency saving $42 billion over a two-year period stretching from the 2013 to 2014 fiscal years. “This equates to an average savings of $12.40 for each dollar spent on Medicare program integrity alone,” the agency noted. “These savings represent funds that remain available to provide needed healthcare to Medicare, Medicaid, and Children’s Health Insurance Program beneficiaries nationwide and reflect the increasing success of CMS’ efforts to proactively prevent improper payments.” Senior healthcare analyst Frank Cohen responds to those comments in this article.

I read through the CMS report several times and while I applaud any effort to reduce fraud, waste, and abuse, I was a bit surprised by the $42 billion figure recorded over just two years. This is the first time I have heard of such a large amount, and I wish that CMS would have provided a better breakdown of where the money came from.

For example, how did they prevent 70 percent of all payments, and where did the remainder come from? And while we’re at it, just what constitutes “savings?” Is it just payments that weren’t made that should have been made?

Read the full article on Racmonitor.com