CMS Plans Provider Website to Better Track Medicare Fraud
Written by Editor   
Wednesday, June 17, 2015 03:57 PM
Quick Brief: CMS wants to launch a system to track enforcement actions against Medicare providers. The federal agency is on the hunt for a contractor to build and maintain the so-called Provider Compliance Reporting system to be accessible on the yet-to-launch ProviderMedicare.gov website.

 

The CMS wants to launch a system to track enforcement actions against Medicare providers over questionable claims. Fraud costs the federal government an estimated $60 billion to $90 billion annually.  The federal agency is on the hunt for a contractor to build and maintain the so-called Provider Compliance Reporting system. It will be accessible on the yet-to-launch ProviderMedicare.gov website.

The CMS now contracts with a number of private companies to protect the Medicare trust fund against fraud by taking a second look at claims.  “However, none of the existing reporting mechanisms allows for a comprehensive view of Medicare's activity with the CMS and its contractors,” the agency said in a solicitation notice. “The CMS needs a system that will allow Medicare review contractors and CMS staff to view a provider profile.”

That profile will show when a provider received one-on-one education and which claims have been flagged for review. Current systems are designed to prevent the same claim from being reviewed by two contractors, however the CMS needs the new system to help ensure the same topic is not being reviewed by two contractors for the same provider at the same time.

Providers will also have access to the new Web resource. “A provider who was reviewed by three different contractors would have to visit three different websites to get a full picture of their review and education activity with Medicare,” the solicitation notice said.

The contract also requires that an outreach campaign be developed around ProviderMedicare.gov, inferring that the public will be able to review information on the site as well.