GOP Questions CMS Anti-Fraud Initiative; Will New Command Center Help?

On July 31, the Centers for Medicare & Medicaid Services (CMS) announced the launch of the new Program Integrity Command Center, meant to speed up the process of identifying fraud and stopping criminals from defrauding the Medicare and Medicaid programs.

The announcement came shortly after Senators Orrin Hatch (R-Utah) and Tom Coburn (R-Okla.), both part of the Senate Finance Committee, sent a letter to CMS Acting Administrator Marilyn Tavenner questioning the agency’s effectiveness in its multi-million dollar anti-fraud initiative. 

The command center is a joint initiative by CMS and the Department of Health and Human Services and will bring Medicare and Medicaid officials together with law enforcement partners from the HHS Office of the Inspector General, the FBI, and CMS’ anti-fraud investigators. New predictive analytics will help experts from a variety of fields, including clinicians, data analysts, fraud investigators, and policy experts, to spot fraud and then quickly take action on leads once potential fraud is identified, said a post on CMS’ official blog


“The result is that investigations that used to take days and weeks can now be done in a matter of hours,” said Dr. Peter Budetti, CMS Deputy Administrator and Director of the Center for Program Integrity, in the blog post. “And this new technology can help detect and prevent potential problems and payments. That can mean millions of taxpayer dollars staying out of the hands of fraudsters.”

This is “one more part” of the Obama Administration’s effort to fight fraud and waste in the healthcare system, Budetti continued.

Last year, CMS awarded a $77 million contract to Northrop Grumman, Verizon, and National Government Services to create the Fraud Prevention System (FPS), a predictive analytics tool to reduce fraud, waste, and abuse in the Medicare program under the National Fraud Prevention Program.


However, GOP Senators Hatch and Coburn say that CMS has “failed to provide any quantitative or reliable data showing even preliminary results of the program” in response to “repeated” requests, according to Hatch’s website.

“For some time, we have heard a growing chorus of concerns from a wide range of credible entities who have expressed concerns about the FPS,” say the senators in the letter. “Today we are writing to express our increasing concerns about three specific categories of concerns related to the FPS: the performance metrics to assess the effectiveness of FPS, the targeting of claims for reviews, and transparency about results from the system.”

In the letter, the senators requested data that CMS respond to their “common-sense” questions by August 31, 2012. 

Read more about the new Command Center.

Written by Alyssa Gerace

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