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Senators Batter CMS Over Anti-Fraud Efforts

Cheryl Clark, for HealthLeaders Media, July 14, 2011

Committee Chairman Sen. Tom Carper, (D-DE), asked CMS's director for the Center for Program Identity Peter Budetti, MD, "When will we have more people trained and when will state Medicaid offices have access to this information?"

Brown added, CMS was "supposed to have 639 (trained by the end of the fiscal year. Looks like we're a little short," he said, on personnel necessary "to use a system that cost $100 million."

"Are we getting a good value? Is it reaching its full potential? It doesn't seem to be but maybe I'm missing something," he added.

Budetti responded that the number of analysts scheduled for training was set a number of years ago, and implied that may not be the number that would still be trained to use the system. However, he clarified that another 55 analysts had been trained to date.

Budetti touted CMS's launch on July 1 of predictive analytics technology that screens claims before payment. The technology is similar to that used by  credit card companies to analyze customers' spending trends and quickly detect irregularities, and to stop those claims from being paid until they are properly investigated.

Lewis Morris, chief counsel for the U.S. Office of Inspector General, who appeared as one of the hearing's witnesses, said, however, that there have been only 53 payment suspensions initiated at the OIG's request, representing about $8 million, since the passage of the Affordable Care Act last year.

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