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Senators Batter CMS Over Anti-Fraud Efforts

Cheryl Clark, for HealthLeaders Media, July 14, 2011

The Centers for Medicare & Medicaid Services took a beating from members of a Senate subcommittee Tuesday for incomplete implementation of fraud prevention programs and for missing key deadlines.

A cornerstone of the nearly two-hour hearing included the release of a particularly negative report from the U.S. Government Accountability Office, which said CMS had allowed only 42 of 639 analysts to undergo training to use a database that was tailored to identify fraud and questionable claims worth $21 billion over 10 years. 

Additionally, CMS has not incorporated any data from Medicaid claims, a major potential source of healthcare fraud and abuse, into the system, GAO charges.

The system, as it is, "entices predators...to gorge on the cash cow, which these programs represent, and it's the government's chronic mismanagement of Medicare and Medicaid fraud prevention that's landed both programs on the GAO's high risk list for many years," said Sen. Scott Brown, (R-MA).

Brown is ranking member of U.S. Senate Subcommittee on Federal Finance Management, of the Committee on Homeland Security and Government Affairs, which held the hearing, "Harnessing Technology and Innovation to Cut Waste and Curb Fraud in Federal Health Programs."

"The government's history of overseeing the performance of these programs in the last few decades does not indicate a history of success," Brown added. "In light of the burgeoning wave of healthcare spending and history of lax oversight, we need to do more and we need to do it quickly."

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