CMS behind schedule on high-tech fraud detection system

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The Centers for Medicare & Medicaid Services has fallen behind schedule in creating a predictive-modeling system to combat Medicare and Medicaid fraud, according to a Government Accountability Office report unveiled this week.

Although the agency rolled out a fraud prevention system in July 2011, it does not integrate with CMS' payment-processing system, work that was supposed to begin last summer. Now the agency says the work likely won't begin until January.

GAO reported that program officials blamed the lack of progress on not having enough time to develop system requirements. According to the report, CMS has yet to define or measure quantifiable benefits or performance goals. "Until program officials review the effectiveness of the system based on …measurable performance targets, they will not be able to determine the extent to which FPS is enhancing CMS's ability to accomplish the goals of its fraud prevention program."

Sen. Tom Carper (D-Del.), one of three senators who said his questions about the system's implementations had been ignored by CMS, called the system one with "enormous potential for fighting … waste and fraud," but said in a statement that the agency "needs to do more … to get the system fully up and running."

Sen. Tom Coburn, M.D. (R-Okla.), meanwhile, pulled no punches, calling CMS's lack of progress "troubling."

"Unfortunately, GAO has found that even after spending $77 million on the program, CMS has no idea whether it is saving money or preventing fraud," he said.

The system's creation was authorized by the Small Business Jobs Act of 2010.

To learn more:
- read the full report (.pdf)
- here are the report's highlights (.pdf)
- read this announcement from Sen. Tom Carper

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