Home Health & Hospice

CMS Fraud Prevention System identified or prevented over $210 million in improper Medicare payments

Homecare Insider, August 4, 2014

CMS reports that its Fraud Prevention System (FPS) identified or prevented more than $210.7 million in improper Medicare fee-for-service payments during fiscal year 2013, its second year in operation—almost double the returns from the first year of the program. It also resulted in CMS taking action against 938 providers and suppliers, according to a report the organization sent to Congress.

The savings associated with these prevention and detection actions, which were certified by the Office of Inspector General, resulted in more than a $5 to $1 return on investment, an increase from last year’s $3 to $1 return, the report states.
The FPS, implemented in June 2011, runs predictive analytics against Medicare fee-for-service (FFS) claims throughout the country prior to payment to identify potential instances of fraud. In the future, CMS expects to expand the use of the FPS into the areas of waste and abuse, which it anticipates will further increase savings.