Record Recovery of $4 Billion last year

The CMS Fraud Prevention Initiative aims to ensure that correct payments are made to legitimate providers for covered appropriate and reasonable services in all federal health care programs. 

Fraud prevention efforts focus on moving CMS beyond its former “pay and chase” recovery operations to a more proactive “prevention and detection” model that will help prevent fraud and abuse before payment is made.  A good example is the recent CMS announcement that for the first time, through the use of innovative predictive modeling technology similar to that used by credit card companies, the agency will have the ability to use risk scoring techniques to flag high risk claims and providers for additional review and take action to stop payments and remove providers from the program when necessary.

This information is available in the CMS Fraud Prevention Toolkit on the web at https://www.cms.gov/Partnerships/04_FraudPreventionToolkit.asp.

HOME HEALTH AGENCIES SHARE $15 MILLION IN SAVINGS FROM CMS QUALITY DEMONSTRATION

PAY FOR PERFORMANCE (HHP4P) INTERVENERS USED EFFICIENCIES, QUALITY MEASURES TO CUT HH COSTS

The Centers for Medicare and Medicaid Services (CMS) announced on Tuesday, July 05, 2011 that it will share nearly $15 million in additional savings with more than 100 Home Health Agencies (HHAs) that participated in the intervention group of the two-year Medicare Home Health Pay for Performance (HHP4P) demonstration.

All Medicare-certified HHAs in seven states representing the four U.S. Census regions were invited to participate in the demonstration:  

• the Northeast included HHAs in Connecticut and Massachusetts,
• the South included HHAs in Alabama, Georgia, and Tennessee, and
• the Midwest and West regions included HHAs in Illinois and California, respectively. 

A total of 123 HHAs out of 270 participating in the demonstration intervention group will receive incentive payments from savings based on their performance during the second year of the Medicare HHP4P demonstration.   For Year 2, the demonstration calculated aggregate savings of $14.95 million for two of the four demonstration regions.  The Midwest and the Northeast regions did not achieve any savings and, therefore, were not eligible to receive incentives.

 

The Medicare HHP4P demonstration is still being evaluated, with additional results expected later in 2011.  For the detailed press release, click here - http://go.cms.gov/nNqdQT