Politico reported on new GAO Reports showing waste and fraud in Medicare and Medicaid programs.  Medicare needs better use data programmed into claims processing systems to stop fraud.  Medicare is estimated to have made $28.8 billion in improper payments in 2011, according to GAO. Medicaid was estimated to have made $21.9 billion in bad payments — a higher percentage of its outlays than Medicare’s bad payments because it is a smaller program.

The Department of Health and Human Services agreed with the assessments and said it’s in the process of strengthening the Medicaid anti-fraud efforts, in part to respond to the expected expansion of the program next year under health reform. On Medicare, GAO recommended that CMS strengthen the use of pre-payment edits, controls that are programmed into claims processing to screen for potentially fraudulent activity. GAO said Medicare needs to restructure some of the data and make it easier to use. HHS generally agreed.



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