CMS Boston official outlines agency's program integrity changes

"Each of the major components have a significant impact on program integrity and create challenges as well," Bryant said.

He also discussed the following:

Expect increase in data analysis for error rate program
CMS will also increase its use of data analysis to tailor program integrity efforts, including drug card usage data and its Comprehensive Error Rate Testing (CERT) Program. This program will help CMS determine a national error rate of paid claims by provider, bill category, and Medicare contractor. Bryant noted the increased fraud and abuse issues with power scooters and motorized wheelchairs as a wakeup call to the government to find better ways to use data. "If we had focused our energy better, and mined data better, we might have been able to find the problem sooner."

Specialty contractors come to the forefront
CMS will use a new specialty contractor for the CERT program, and a new source in Region A (New England) to handle fraud and medical review to allow the existing contractor to focus on claims processing issues and education. Another change is the opening of special program integrity offices in "hot" locations, including Miami-"which was a hotbed of misconduct in the DME (durable medical equipment) area"-and Los Angeles, which had spikes in home health-related and other types of fraud.

CMS to increase emphasis and support of compliance programs
The agency wants to "incent, encourage, and reward" providers for being effective. Bryant cited the compliance effectiveness pilot and subsequent best practice guidelines as an example.

Editor's note: Look to upcoming issues of Strategies for Health Care Compliance for more news and analysis of CMS initiatives.