Command Center Speeds Up Anti-Fraud Efforts

By Dr. Peter Budetti, CMS Deputy Administrator and Director of the Center for Program Integrity

Today, I had the privilege of joining HHS Secretary Kathleen Sebelius and CMS Acting Administrator Marilyn Tavenner to open the new CMS Program Integrity Command Center that is speeding up the process of identifying fraud, and stopping criminals from defrauding Medicare and Medicaid.

The new Command Center is bringing together Medicare and Medicaid officials, as well as law enforcement partners from the HHS Office of the Inspector General, the Federal Bureau of Investigation, and CMS’s anti-fraud investigators. The Command Center will gather experts from all different areas – clinicians, data analysts, fraud investigators, and policy experts – into the same room to build and improve our sophisticated new predictive analytics that spot fraud, and to then move quickly on a lead, once potential fraud is identified. The technology also allows us to connect with field offices to track down leads in real time.

The result is that investigations that used to take days and weeks can now be done in a matter of hours. And this new technology can help detect and prevent potential problems and payments. That can mean millions of taxpayer dollars staying out of the hands of fraudsters.

This is one more part of the Obama Administration’s effort to fight fraud and waste in our health care system. The health reform law gives law enforcement more tools to go after fraudsters, and establishes tougher sentences once we catch those criminals. We’re already seeing results – four years ago, the government recovered just over $1 billion in fraudulent payments; this year, it’s over $4 billion, a record number. We’ve had the largest health care fraud busts in history in 2012.

Below, view a preview of this exciting facility that’s helping us protect the Medicare and Medicaid programs:

Supporting Every Provider in Delivering Better, More Coordinated, Patient-Centered Care

By Dr. Rick Gilfillan, Director, Center for Medicare & Medicaid Innovation

This month, 88 new Accountable Care Organizations (ACOs) joined the other Medicare Shared Savings Program ACOs that came on line earlier this year.  Now, more than 150 organizations are partnering with Medicare in shared savings initiatives and offering more than 2 million patients better, more coordinated, patient-centered health care.

At the Centers for Medicare & Medicaid Services (CMS), we see ACOs as part of the future of health care—part of a broader movement from the old fee-for-service system that simply paid more for more services regardless of the outcome, to one that rewards providers for high-quality, coordinated care. 

Providers also see ACOs as a path to better health care.   During the rulemaking process for the Medicare Shared Savings Program, our agency heard from many small practices who wanted to become ACOs, but needed additional capital to meet the high bar for care coordination required of an ACO.  

We want to make sure that healthcare providers interested in forming ACOs have the opportunity to do so.  That’s why we created the Advance Payment Model—to provide entities such as rural and physician-owned organizations that hope to become ACOs in the Medicare Shared Savings Program with the support they need to invest in staff and in health information technology.  They will repay Medicare through savings they achieve.

Last week, CMS was proud to announce the second group of fifteen Advance Payment ACOs.  These organizations join five Advance Payment ACOs announced earlier this year.  Like their Medicare Shared Savings Program colleagues, they represent communities across America, and are made up of a diverse group of healthcare providers, including independent practice associations that are owned and operated by physicians. 

The interest of these small, independent practices in the ACO model demonstrates that the desire to improve care and lower costs through improvement exists in small practices as well as large health systems.  These providers are committed to improving the health and health care of their patients over the long haul. 

Recently, CMS announced that organizations accepted to the Medicare Shared Savings Program for January, 2013 would also have the opportunity to apply for Advance Payment Model.  At CMS, we’re committed to an ACO program that supports a diverse set of ACOs, allowing groups ranging from health systems to physician-led organizations to partner with us.

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