Kusserow on Compliance: CMS program integrity reports saving $40B over two years

CMS issued its 2016 mandated annual program integrity report to Congress that addresses activities during fiscal years 2013 and 2014.  The agency reported that its program integrity activities saved Medicare over $39 billion, for a two-year return on investment of $12.4 to 1.  Over 70 percent in aggregate was the result of prevention of improper payments.  Recovery of overpayments represented only about one-fourth of the total savings with Reviews and Audit recoveries of about $5 billion, Recovery Auditor Collections of about $6 billion, and Law Enforcement Referrals of $230 million.  During the same period, CMS had about 1,000 active payment suspensions. Prevention of improper payments continues to increase as CMS proceeds with its proactive approach to program integrity.

The report also addressed the CMS Medicaid Integrity Program.  CMS directed the Audit Medicaid Integrity Contractors (MICs), which identified roughly $50 million in overpayments for recovery by states. Through Audit MIC activities, the states returned the federal share of $11 million to the Treasury. Through the State Medicaid Recovery Audit Programs, the states have recovered a total federal and state share combined amount of about $230 and returned the federal share of $140 million to the Treasury.

Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.

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Copyright © 2016 Strategic Management Services, LLC. Published with permission.