CMS Publishes Notice of Computer Matching Program to Detect Fraud, Waste & Abuse

On December 28, 2006, the Centers for Medicare & Medicaid Services (CMS) published a Notice in the Federal Register announcing a Computer Matching Program (CMP) that CMS plans to conduct with various participating states to study claims, billing and eligibility information to detect suspected instances of Medicare and Medicaid fraud, waste and abuse. 

Through the CMP, CMS and a participating state will provide a CMS contractor with Medicare and Medicaid claims, billing and eligibility records, which the CMS contractor will match in order to merge the information (as necessary) to conduct the match.  Utilizing fraud detection software, the information will then be used to identify patterns of aberrant practices and abnormal patterns requiring further investigation.

On December 20, 2006, CMS filed a report on the CMP with the House Committee on Government Reform and Oversight, Senate Committee on Homeland Security and Governmental Affairs, and Office of Management and Budget (OMB).  According to the Notice, the CMP will become effective 40 days after the report is filed with Congress and OMB, or 30 days after publication in the Federal Register, which ever is later. 

The CMP will continue for 18 months from the effective date and may be extended for an additional 12 months thereafter, if certain conditions are met.  CMS is accepting comments on the CMP, and may defer implementation if comments persuade CMS to do so.