“To curb Medicare fraud, the Trump administration is designing a five-pronged integrity strategy for the program.”
“Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma unveiled the effort in a blog post Monday afternoon. The goal, Verma said, is to work on multiple fronts to ‘modernize our approach and protect Medicare for future generations…’”
“The five ‘pillars’ of the program, Verma wrote, are:
- Stopping bad actors. The agency will work alongside law enforcement to identify and prosecute fraudulent behavior quickly.
- Fraud prevention. CMS will make systemic changes after fraud is identified to ensure similar schemes don’t happen in the future, Verma said. CMS is also working to preemptively identify problems or high-risk areas and make policy changes to address them.
- Tracking ‘new and emerging’ risks. Tackling fraud is like playing a game of whack-a-mole, Verma wrote—new risks pop up as others are addressed. CMS has taken steps such as continued use of prior authorization and value-based models in Medicare Advantage to be proactive.
- Ease provider burdens. CMS has made provider burden a key focus under Trump, Verma said. Streamlining administrative work can prevent fraud by eliminating clerical errors.
- Take advantage of new technology. CMS wants to harness emerging tech platforms to automate and modernize its program integrity efforts.”
“Alongside the blog post, CMS released two requests for information (RFIs) to gather feedback on ways it can further these efforts. In the first, it is seeking comments on ways it can most effectively take advantage of technology to improve its programs combating fraud or to ease the burdens on providers.” Read the full article here.
Source: CMS unveils 5 ‘pillars’ to curbing fraud, waste in Medicare – By Paige Minemyer, October 22, 2019. FierceHealthcare.
