Home Health & Hospice Week

Watch for Medicare to continue Fraud Prevention System ramp-up.

Know your data, so you can identify and correct problems before the feds do.

Over the past five years, the Centers for Medicare & Medicaid Services “has successfully implemented a Fraud Prevention System using ‘big data’ and predictive analytics approaches to fight fraud, waste and abuse in the Medicare fee-for-service program,” CMS crows in a new release about its fraud-fighting program.

One of the three success stories about FPS that CMS includes in the release is about a home health agency. “The FPS identified a home health agency in Florida that billed for services that were never rendered,” the agency says. “Due to the FPS, CMS placed the home health agency on prepayment review and payment suspension, referred the agency to law enforcement, and ultimately revoked the agency’s Medicare enrollment.”

The other examples reference an ambulance provider in Texas and a physician practice in Arizona. “This predictive analytics technology contributed to more than $1 billion in savings in 2014 and 2015,” CMS touts in the release.

With the stats CMS flaunts, you can expect to see more predictive data applications ahead. “Since the beginning of the program, over $1.5 billion in inappropriate payments has been identified by the system through new leads or contributions to existing investigations,” CMS says. “Also, in 2015, the CMS marked its first-ever national return-oninvestment of $11.60 for every dollar the federal government spends on this program integrity system.”

Ahead: “CMS is now working to develop next-generation predictive analytics with a new system design that even further improves the usability and efficiency of the FPS,” the agency vows.

Resource: See Medicare Program Integrity links, including to FPS reports, at www.cms.gov/about-cms/components/cpi/center-for-programintegrity.html.