Part D prompts government crack down on Medicare fraud

Dec 01, 2005

Washington--The roll-out of the new Medicare drug benefit and expansion in the Medicare Advantage (MA) program is prompting the Centers for Medicare and Medicaid Services (CMS) to develop a comprehensive strategy to assess the risk of "improper payments" to MA plans. In the coming year, CMS will take a series of steps to measure the accuracy of these payments and address potential risks, beginning with a review of whether all required data is submitted for accurate monthly payments to plans. The agency will examine whether beneficiaries are eligible to enroll in a plan, how payments are made and what occurs when a beneficiary's enrollment is terminated.

WASHINGTONThe roll-out of the new Medicare drug benefit and expansion in the Medicare Advantage (MA) program is prompting the Centers for Medicare and Medicaid Services (CMS) to develop a comprehensive strategy to assess the risk of "improper payments" to MA plans. In the coming year, CMS will take a series of steps to measure the accuracy of these payments and address potential risks, beginning with a review of whether all required data is submitted for accurate monthly payments to plans. The agency will examine whether beneficiaries are eligible to enroll in a plan, how payments are made and what occurs when a beneficiary's enrollment is terminated.

Also, CMS will work with Medicare Rx Integrity Contractors (MEDICs) in identifying and preventing fraud and abuse in the Medicare drug program.

CMS announced a $9.5 billion reduction in improper claims payments under the Medicare fee-for-service (FFS) program, largely because of a big drop in errors on claims. Now the agency aims to build on this success by extending its Medicare Integrity Program to Medicare managed care and prescription drug plans, as well as to Medicaid and state children's health programs. In 2007, CMS plans to measure improper payments in Medicaid managed care and FFS as part of broader efforts to help states keep error rates down and ensure accurate payments.

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