Program Integrity Saves Medicare $42 Billion

By Kelly Hardy Briganti, Editorial Director, G2 Intelligence

In a new report to Congress, the Centers for Medicare & Medicaid Services reports the Program Integrity activities have saved Medicare and Medicaid $42 billion during Fiscal Years 2013 and 2014 (Oct. 1, 2012—Sept. 30, 2014). The agency claims $12.40 was saved for every dollar spent on program integrity efforts. Those efforts included a focus on ensuring providers seeking to enroll in Medicare are properly screened, using predictive analytics to identify fraud and abuse, and coordination with law enforcement. Specifically, the agency credited assistance from Medicare contractors, state Medicaid agencies and law enforcement for these successes.

“CMS has achieved this impact by using a multifaceted approach ranging from provider enrollment and screening standards, to use of enforcement authorities, to use of advanced analytics such as predictive modeling,” said Shantanu Agrawal, M.D., deputy administrator and director, Center for Program Integrity, in a CMS Blog post announcing the report. The report also claims savings due to preventing fraud and abuse increased to 74 percent. Prior year’s savings was 68 percent. “This development means that more taxpayer dollars intended to care for the beneficiaries are not being paid at all, avoiding the need to recover improperly paid amounts from health care providers and suppliers,” explained Agrawal.