Four New CMS Payment Demonstration Projects Aim to Prevent Improper Medicare, Medicaid Payments

<p>
Four Medicare and Medicaid payment demonstration projects were announced Tuesday as part of a larger effort to continue to reduce provider payment errors.</p>
<p>
The effort is called &ldquo;Campaign to Cut Waste&rdquo; and is part of an executive order issued by President Obama in an effort to prevent improper payments by both Medicare and Medicaid, as well as food stamp programs and Pell Grants.</p>
<div style="page-break-after: always;">
<span style="display: none;">&nbsp;</span></div>
<p>
&ldquo;The American people must be able to trust that their Government is doing everything in its power to stop wasteful practices and earn a high return on every tax dollar that is spent,&rdquo; Obama wrote in the June 13 &nbsp;<a href="http://www.whitehouse.gov/the-press-office/2011/06/13/executive-order-delivering-efficient-effective-and-accountable-governmen">order</a>.&nbsp;&ldquo;To strengthen that trust and deliver a smarter and leaner Government, my Administration will reinforce the performance and management reform gains achieved thus far; systematically identify additional reforms necessary to eliminate wasteful, duplicative, or otherwise inefficient programs; and publicize these reforms so that they may serve as a model across the Federal Government.&rdquo;</p>
<p>
Currently implemented waste reduction measures have decreased Medicare&rsquo;s payment error rates from 10.2 percent in 2010 to 8.6 percent in 2011. Plus, Medicare&rsquo;s fee-for-service error rates have dropped from 9.1 percent last year to 8.1 percent this year.</p>
<p>
And, according to a statement released by the White House yesterday, the Obama administration was successful in cutting &ldquo;wasteful improper payments by $17.6 billion in 2011&rdquo; during the Campaign to Cut Waste. Combined with the improper payment cuts in 2010, more than $20 billion has been avoided in two years.</p>
<p>
<strong>Pilot Programs Expected to Strengthen Payment Oversight</strong></p>
<p>
HHS Secretary Kathleen Sebelius made the Tuesday announcement. She said that <a href="https://www.cms.gov/apps/media/press/factsheet.asp?Counter=4176&amp;intNumPerPage=10&amp;checkDate=&amp;checkKey=&amp;srchType=1&amp;numDays=3500">four new pilot programs</a> were created to further reduce Medicare and Medicaid error rates, waste and fraud. The programs are scheduled to launch in January 2012.</p>
<p>
The Obama administration expects to prevent up to $50 billion in payment errors by the end of 2012 through the implementation of these new programs.</p>
<p>
&quot;When the President and I launched the Campaign to Cut Waste we knew success would be measured by results, not rhetoric,&quot; Vice President Joe Biden said in a <a href="http://www.whitehouse.gov/the-press-office/2011/11/15/we-can-t-wait-agencies-cut-nearly-18-billion-improper-payments-announce-">statement</a>. &quot;The sharp reduction in payment errors announced today demonstrates this Administration is serious about cutting waste.&quot;</p>
<p>
OMB Director Jack Lew said that the White House is seeing real progress as it cracks down on the &ldquo;waste of taxpayer dollars that has persisted for far too long.&rdquo;</p>
<p>
&ldquo;Through aggressive and innovative solutions being deployed by Federal agencies, we are on track to meet the President&rsquo;s bold directive to prevent $50 billion in payment errors by the end of 2012,&rdquo;<br />
&nbsp;Lew said in a statement. &ldquo;This is a good step, but not the end. We will continue to work day and night to prevent taxpayer dollars from being wasted in payments to the wrong people or in the wrong amount.&rdquo;</p>
<p>
The programs were designed to expand the use of RACs to screen certain hospital payments before they&rsquo;re made. This will help to avoid overpayments or wasteful spending. Hospitals will also be allowed to resubmit bills to Medicaid for some services when errors are made, and HHS will be permitted to review certain medical equipment claims before they&rsquo;re submitted. Additionally, an automated tool designed to screen health providers for fraud risk through a partnership will be tested.</p>
<p>
Sebelius said that while this move shows &ldquo;real progress&rdquo; in cutting water, Congress still needs to act on the proposal.</p>
<p>
&quot;Until Congress acts, we will continue doing everything in our power to save money on behalf of the American people,&rdquo; she told <a href="http://thehill.com/blogs/healthwatch/medicare/193715-administration-touts-18-billion-success-in-fraud-prevention-announces-health-efforts">Healthwatch</a> blogger Julian Pecquet.</p>
<p>
<strong>What do you think about the new pilot programs? Will they really reduce wasteful spending and overpayments? Share your thoughts in the comments section. </strong></p>
<p>
<em>You might also like:</em></p>
<ul>
<li>
<a href="../../news/four-key-healthcare-organizations-refuse-to-participate-in-pioneer-aco-program">Four Key Healthcare Organizations Refuse to Participate in Pioneer ACO Program</a></li>
<li>
<a href="../../news/house-nixes-3-percent-withholding-rule">House Nixes 3 Percent Withholding Rule</a></li>
<li>
<a href="../../news/cms-releases-final-aco-rule">CMS Releases Final ACO Rule</a></li>
<li>
<a href="../../news/what-can-we-do-to-better-serve-you">What can we do to better serve you?</a></li>
</ul>