Two CMS systems not working

August 10, 2011

Two information systems designed to detect Medicare and Medicaid fraud are not working as well as they should, according to the Government Accountability Office (GAO).

Two information systems designed to detect Medicare and Medicaid fraud are not working as well as they should, according to the Government Accountability Office (GAO).

The Centers for Medicare and Medicaid Services (CMS), which spent $158 million on the systems, has failed to incorporate data needed for fraud oversight, the GAO report concludes.

In 2006, CMS created a central repository for Medicare and Medicaid claims data to allow the agency and contractors to identify improper payments. The Integrated Data Repository (IDR) does not contain needed Medicaid data, although most Medicare data are available.

The GAO report finds that CMS has made progress towards devloping a single repository of data and analytical capabilities but that the agency "is not yet positioned to identify, measure, and track benefits realized from its efforts."

Because of their susceptibility to improper payments-estimated at $70 billion in 2010 alone-the GAO has designated Medicare and Medicaid as "high-risk programs."

x