The Centers for Medicare and Medicaid Services must do a better job of measuring the effectiveness of its fraud and abuse abatement, the Government Accountability Office says in a new report.
The GAO says that proper measurement tools are important if CMS is to make a significant dent in the estimated $48 billion in improper payments it makes annually, or approximately 10% of the total Medicare expenditures of approximately $500 billion.
GAO says that through an analysis of CMS' budget and other documents, and through interviews with CMS officials, it has learned that CMS uses the return on investment method to measure the effectiveness of Medicare Integrity Program (MIP) activities.
But, GAO says, CMS' key problem in appropriately measuring its fraud and abuse detection system is that its managers have not "clearly communicated" to its staff the relationship between the daily work of conducting so-called "medical integrity program" activities, as measured by the ROI standard, and the agency's improper payment reduction performance goals.
Instead, GAO says, CMS managers used other measures of determining the effectiveness of its fraud abatement programs.
