The CMS said today it is expanding its efforts to root out fraud, abuse and improper payments from federal healthcare programs. Program integrity oversight will be expanded beyond fee-for-service to cover the Medicare drug discount card program, its HMOs and the prescription drug benefit that begins in 2006. The agency also will use more data analysis to uncover fraud. The CMS hired an outside contractor, IntegriGuard, to analyze weekly drug pricing data under the card system to uncover "bait and switch" practices. IntegriGuard also will look for schemes such as fraudulent drug cards and identity theft.
States will be responsible for more scrutiny of Medicaid billing. Under a proposed regulation, each state would be required to review a sample of Medicaid and State Children's Health Insurance Program payments each month looking for improper billings. The rule will be open for public comments until Sept. 27. The proposed rule calls for the CMS to determine a national Medicaid payment error rate based on the data compiled by the 50 states and the District of Columbia. The CMS also will expand a test program to analyze Medicare and Medicaid billings together to uncover schemes that might otherwise go unnoticed, such as a physician or other provider billing both programs for a total of more than 24 hours in a single day. Two states -- Ohio and Washington -- will be added to the seven under the initial test. -- by Vince Galloro