CMS: Verma on the Future of Medicare Program Integrity

“Earlier this month, President Trump announced an Executive Order charging CMS to propose annual changes to combat waste, fraud, and abuse in the Medicare program. That’s why I’m proud to announce our vision to modernize our program integrity methods to better protect taxpayers from fraud, waste and abuse in Medicare. Every dollar spent on Medicare comes from American taxpayers and must not be misused.”

“CMS defines program integrity very simply: ‘pay it right.’  Program integrity must focus on paying the right amount, to legitimate providers, for covered, reasonable and necessary services provided to eligible beneficiaries while taking aggressive actions to eliminate fraud, waste and abuse. Our health care programs are quickly evolving; therefore our program integrity strategy must keep pace to address emerging challenges.”

“Government watchdogs routinely identify concerns about waste and abuse within our programs. The Government Accountability Office (GAO) has designated Medicare as a High Risk program since 1990 because of its size, complexity and susceptibility to improper payments…”

“Medicare’s improper payment rates have declined but remain too high. That’s why CMS is developing a five-pillar program integrity strategy to modernize our approach and protect Medicare for future generations…”

“Looking forward, we are looking to add private sector technology tools to complement our fraud prevention analytics so our future capabilities will be faster, smarter and more robust…” Read the full blog post here.

Source: The Future of Medicare Program Integrity – By Seema Verma, October 21, 2019. CMS Blog.

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