Kusserow on Compliance: CMS and Veterans Affairs partnering to address fraud and abuse

The Department of Veterans Affairs (VA) and CMS announced a partnership to share data, data analytics tools, and best practices for identifying and preventing fraud, waste, and abuse. The Veterans Health Administration is a large integrated health care system operated by the VA and has many issues already being addressed by CMS. Through the Veterans Health Administration, the VA is itself the provider, operating an integrated network of 168 medical centers, more than 1,000 outpatient clinics, 250 brick-and-mortar pharmacies, and seven mail-order pharmacies. The VA health system employs over 200,000 health care professionals and covers about nine million veterans in the US.

The new alliance is intended to enhance ongoing efforts between the country’s two largest public-private health-care payment organizations. This collaboration is intended to identify new and innovative ways to seek out fraud, waste, and abuse. CMS estimates that its program integrity activities saved Medicare operations $17 billion in fiscal 2015. Much of this arises from new practices and technologies that will now be shared with the VA, which will be able to capitalize on the advancements in analytics CMS has made and hopefully it will be able to close existing gaps in its own claims payment process. CMS also noted in its announcement that VA invited industry experts in November 2017 to provide information on the latest commercial sector tools and techniques to enhance VA’s fraud detection capabilities.

 

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 © 2017 Strategic Management Services, LLC. Published with permission.