CMS' antifraud systems are underused, GAO says

The Centers for Medicare and Medicaid Services isn't fully using its anti-fraud IT systems that also aren't working as anticipated, according to a new report from the Government Accountability Office.

The agency has two IT fraud-detection systems that have been operational since 2006. However, the systems have gaps in data and are underused, resulting in shortcomings in identifying the $70 billion in estimated improper payments made by Medicare and Medicaid each year, GAO said in its report of July 11.

The first system, the Integrated Data Repository, is functioning but doesn't have all the data that it was intended to have, GAO said. The agency has been stymied from including all anticipated data by technical issues and gaps in funding, the report said.


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The second system, known as One Program Integrity, was supposed to have 639 users by Sept. 30, 2010. However, there were only 41 users as of October 2010, the GAO said. That represents only about seven percent of the anticipated users. Agency officials blamed the lack of widespread usage on shortcomings in the training plans.

Overall, GAO concluded that it was not possible to know if the IT systems were fulfilling their goals and recovering sufficient payments to cover their costs.

“While CMS has made progress toward its goals to provide a single repository of data and enhanced analytical capabilities for program integrity efforts, the agency is not yet positioned to identify, measure, and track benefits realized from its efforts. As a result, it is unknown whether [the systems] as currently implemented have provided financial benefits,” the GAO report said.

The report recommended making efforts to include more data in the repository and training more people.

CMS managers agreed with the recommendations.

About the Author

Alice Lipowicz is a staff writer covering government 2.0, homeland security and other IT policies for Federal Computer Week.

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