The Centers for Medicare and Medicaid Services (CMS) is implementing aggressive initiatives to find and prevent waste, fraud, and abuse in Medicare. CMS is working closer with beneficiaries and providers; consolidating its fraud detection efforts; strengthening its oversight of medical equipment suppliers and home health agencies; and launching the national recovery audit contractor (RAC) program.
“Because Medicare pays for medical services and items without looking behind every claim, the potential for waste, fraud and abuse is high,” said CMS Acting Administrator Kerry Weems. “By enhancing our oversight efforts, we can better ensure that Medicare dollars are being used to pay for equipment or services that beneficiaries actually received while protecting them and the Medicare trust fund from unscrupulous providers and suppliers.”
As part of these enhanced efforts, CMS is consolidating its efforts with new program integrity contractors that will look at billing trends and patterns across Medicare. They will focus on companies and individuals whose billings for Medicare services are higher than the majority of providers and suppliers in the community. CMS is also shifting its traditional approach to fighting fraud by working directly with beneficiaries and ensuring that they received the durable medical equipment or home health services for which Medicare was billed and that the items or services were medically necessary.