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Home Health & Hospice Week

Industry Note:

CMS Fraud Program Crunches Data At Big Brother Levels

Published on Fri Apr 20, 2012

The Medicare program may have a closer eye on you than you think. CMS "has implemented a major data-gathering, data-mining and data-matching program," points out law firm Duane Morris in a client alert. "While the implementation of this program appears to have been virtually unnoticed, providers should be aware of the nature and volume of information that CMS has been gathering about them and how this information is being, and can be, used," the firm warns. CMS is transitioning away from pay-and-chase recoveries and toward more proactive prepayment screening, Duane Morris notes. The agency is using claims screening tools to pick up aberrant billing patterns, then passing that information along to the Zone Program Integrity Contractors (ZPICs) or law enforcement. Bottom line: "Providers should assume that every claim they submit will be subjected to prepayment screening, which will provide CMS with a vast amount of information about every provider that [...]
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