Fraud efforts hurt by IT woes
The CMS is running years behind schedule in incorporating Medicaid claims and other transaction data into its latest suite of fraud-fighting tools—a delay that is attracting some unwelcome political attention amid the deficitslashing zeal on Capitol Hill.
The federal agency has spent at least $161 million rolling out two new systems in an effort to cut into the $70 billion that HHS estimates was lost to fraud and accidental overpayments in Medicare and Medicaid in 2010.
The new systems were expected to save the federal treasury $21 billion over 10 years by cutting the improper payments.
But a 50-page report released last week by the Government Accountability Office chided the CMS for its apparent sloth in deploying the two systems—the Integrated Data Repository and the One Program Integrity initiative.
“The GAO is not off base,” said Barry Johnson, president of Salt Lake City-based Healthcare Insight, a private firm that does pre-payment insurance claims reviews. CMS officials “talk about doing all these things and you get excited for change,” he said. “And here we are a year and half later, and they’ve trained 40 people.”
GAO auditors said that only 42 of 639 contractors who were supposed to be trained on the program by 2010 actually had been, and that the state-based Medicaid data that was supposed to enter the systems in 2010 is now on track for entry in 2014. And since no benchmarks for performance had been set, it was impossible to tell whether the programs had saved any money, let alone some fraction of the $21 billion.
In written remarks and testimony to a congressional committee, Joel Willemssen—the managing director of information technology for the GAO—went so far as to compare the CMS’ current efforts to centralize its Medicaid claims to the Medicare Transaction System of the 1990s.
The CMS spent more than $100 million on the transaction system in the mid-90s, after saying it would cost only $37 million. Congress voted to cancel all future funding, causing the CMS to permanently shelve the program, after the GAO predicted the ultimate price tag could rise to more than $1 billion (Sept. 22, 1997, p. 26).
“There are similarities and there are differences,” Willemssen said, comparing the failure of the transaction system with the CMS’ current programs, in July 12 testimony before the Senate Subcommittee on Federal Financial Management, Government Information, Federal Services and International Security. “One area of similarity is