CMS to Use New Fraud Mapping Tool

WASHINGTON — The White House is expanding the use of a new
fraud mapping tool across the federal government, and it is
beginning with CMS, administration officials announced June 18.

“We are starting our efforts at CMS since Medicare and Medicaid
combined had about $65 billion in improper payments in FY 2009
— including about $47 billion in Medicare alone — with
fraud being a contributor to this problem over time,” according to
a fact sheet posted by Peter R. Orszag, director of the Office of
Management and Budget.

In 2009, Orszag wrote in a blog, improper payments by government
agencies totaled nearly $110 billion, the highest amount to
date.

Originally developed to keep tabs on the billions of dollars
being disbursed under the American Recovery and Reinvestment Act,
the fraud mapping tool uses data capture and analytics to identify
potential fraud and error. Orszag said he was “really impressed” by
the tool. “It gathers enormous quantities of information — in
real time — and then analyzes the data and helps connect the
dots to identify indicators of possible fraud or error,” he
described.

Specifically, CMS will use the tool to help handle the thousands
of tips about fraud it receives through the 1-800-MEDICARE system.
In addition, a pilot project will use the tool to identify suspect
providers among a list of those in a particular geographic region
where fraud has been identified.

The results will help to validate providers already identified
as high-risk and to point up additional high-risk providers
previously deemed legitimate by the current agency process.

President Obama has also issued a memo establishing a “Do Not
Pay List,” a single source through which all agencies can check the
status of a potential contractor or individual.

“Too often, an agency does not check all the different databases
the government has or finds it difficult to do so,” Orszag said.
“This denies agencies essential information they need to determine,
for example, if an individual is alive or dead or if a contractor
had been debarred. In fact, over the past three years, federal
auditors have reported that the government paid out benefits
totaling more than $180 million to approximately 20,000 Americans
who were dead; and more [than] $230 million in benefits to
approximately 14,000 fugitive felons or those in jail and who are
not eligible for benefits.”

Orszag said both measures would help to meet the president’s
goal of cutting Medicare’s improper payment rate in half by
2012.

Read Orszag’s blog and see the fact sheet at
www.whitehouse.gov/omb/blog/10/06/18/Do-Not-Pay-Do-Read-This-Post/.