Article Explores CMS’s Efforts to Reduce Fraud without Restricting Care

January 23, 2015 | Strategic Insights for Ambulatory Care


​Medicare inspectors are not required to visit medical providers deemed to present a lower risk of fraud and abuse, which creates a vulnerability that some individuals have used to exploit the federal healthcare program, reports a December 25, 2015, Wall Street Journal article. According to the article, many stakeholders feel that the Centers for Medicare and Medicaid Services' (CMS) vetting of new providers is often inadequate; however, the agency faces the challenge of reducing fraud and abuse as much as possible without restricting access to medical care for the 50 million people who depend on the program. Beyond tighter screening of medical providers when they initially enroll in the program, some legislators quoted in the article believe that CMS also needs more rigorous enforcement to kick out the "bad actors" that find their way in.

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