CMS Should Change Funding Structure For Medicare Integrity Program To Better Pre

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CMS Should Change Funding Structure For Medicare Integrity Program

To Better Prevent Fraud, GAO Says

http://www.medicalnewstoday.com/medicalnews.php?newsid=53960

CMS should improve allocation of funds to the Medicare Integrity

Program, which identifies and contests improper payments caused by

fraud and abuse within the federal agency, according to a report

from the Government Accountability Office, CQ HealthBeat reports.

For fiscal years 1997 through 2005, CMS' MIP expenditures increased

for each of its five program integrity activities. Throughout those

years, the agency's allocation for audits increased by about 45% to

$207.6 million, by 40% for medical reviews to $165.9 million, by 49%

for secondary payers to $151.5 million and by 89% for benefit

integrity to $118.5 million, according to CQ HealthBeat. CMS also

increased its allocation for provider education by 590% following a

FY 2002 decision to use MIP funds for outreach activities to health

care providers. The report recommends that CMS allocate funds to MIP

based on the effectiveness of its program integrity activities and

the workload and risk of contractors who review claims and identify

fraud under the program. CQ HealthBeat reports that CMS also may

need to reallocate funds from Medicare parts A and B to account for

program integrity activities related to the Medicare prescription

drug benefit. CMS agreed with most of GAO's findings, but expressed

concern that the report emphasized a quantitative measure to track

dollars saved in relation to dollars spent as a method for

allocating funds. CMS said the measure could be used as an indicator

of effectiveness but not as the basis for funding decisions (CQ

HealthBeat, 10/10).