Monday, August 18, 2014

CMS Fraud Prevention System Identified Savings from (First/Second) Year (millions)


1.    Amount denied by pre payment edits 11.5/16.8

2.    Billed amount denied by auto-denial edits 4.7/1.6

3.    Payment suspensions 1.6/2.3

4.    Amount of overpayments referred for recovery 4.4/35.6

5.    Value of law enforcement referrals 68.2/73.2

6.    Cost avoidance due to changes in behaviour 11.1/NA

7.    Cost avoidance from revoking provider billing privileges 13.9/81.2

8.    Total 115.4/210.7


Source: Centers for Medicare & Medicaid Services

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