CMS Should Change Funding Structure for Medicare Integrity Program To Better Prevent Fraud, GAO Says
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).The report is available online.
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