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.

Related stories:

Government said lagging on anti-fraud technologies

More improper payments identified at FEMA, SSA

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.

FCW in Print

In the latest issue: Looking back on three decades of big stories in federal IT.


  • Anne Rung -- Commerce Department Photo

    Exit interview with Anne Rung

    The government's departing top acquisition official said she leaves behind a solid foundation on which to build more effective and efficient federal IT.

  • Charles Phalen

    Administration appoints first head of NBIB

    The National Background Investigations Bureau announced the appointment of its first director as the agency prepares to take over processing government background checks.

  • Sen. James Lankford (R-Okla.)

    Senator: Rigid hiring process pushes millennials from federal work

    Sen. James Lankford (R-Okla.) said agencies are missing out on younger workers because of the government's rigidity, particularly its protracted hiring process.

  • FCW @ 30 GPS

    FCW @ 30

    Since 1987, FCW has covered it all -- the major contracts, the disruptive technologies, the picayune scandals and the many, many people who make federal IT function. Here's a look back at six of the most significant stories.

  • Shutterstock image.

    A 'minibus' appropriations package could be in the cards

    A short-term funding bill is expected by Sept. 30 to keep the federal government operating through early December, but after that the options get more complicated.

  • Defense Secretary Ash Carter speaks at the TechCrunch Disrupt conference in San Francisco

    DOD launches new tech hub in Austin

    The DOD is opening a new Defense Innovation Unit Experimental office in Austin, Texas, while Congress debates legislation that could defund DIUx.

Reader comments

Please post your comments here. Comments are moderated, so they may not appear immediately after submitting. We will not post comments that we consider abusive or off-topic.

Please type the letters/numbers you see above

More from 1105 Public Sector Media Group