Fierce Healthcare has reported that The Centers for Medicare & Medicaid Services (CMS) launched the Fraud Detection Operation Center (FDOC) to fight waste, fraud, and abuse. The “fraud War Room” is a real-time operations center which leverages the Fraud Prevention System (FPS), built and operated by federal contractor Peraton. “The FPS uses artificial intelligence and machine learning models to flag potentially fraudulent behavior by providers, allowing investigators to more easily see whether a provider should be funneled to the government’s case management system,” according to the report. Providers are susceptible to having federal payments paused or licenses revoked after a review.
The new FDOC webpage was a bit hard for me to find. The website encourages patients to notify CMS if they get a claim for services they don’t recognize and provides the 1-800 number and weblink that patients can use to report possible Medicare fraud, as well as possible fraud in the Health Insurance Marketplace and Medicaid. One of the “recent success stories” includes the following:
“The CMS Fraud Defense Operations Center stopped more than $1 million from being paid to a medical group practice that was billing Medicare for wound care services that were supposedly being performed on patients by the owner, who is a psychiatrist.”
I find that example interesting because in the past, it was hard to get any government official interested in such relatively small amounts of money.
Dr. Fife is a world renowned wound care physician dedicated to improving patient outcomes through quality driven care. Please visit my blog at CarolineFifeMD.com and my Youtube channel at https://www.youtube.com/c/carolinefifemd/videos
The opinions, comments, and content expressed or implied in my statements are solely my own and do not necessarily reflect the position or views of Intellicure or any of the boards on which I serve.
Yes, right. For more than ten years potential cases had to be more than a million before they go after them. It is well known. Some fraudsters set up practices that bill for undelivered services to fake patients up to $1,000,000 and then dissapear. I have a lawyer friend who works in a medicare regional office, who told me they had so many cases (and so little staff) two years ago that they were not going after fraudsters unless they had reason to believe it was $15 million or more.