January 11, 2016
Peter Budetti in Pacific Standard, 1/11/16.
Budetti, who preceded [Director of the Center for Program Integrity Shantanu] Agrawal at CMS and was in charge of program integrity during implementation of the fraud prevention system, says the system was designed to minimize the potential for unnecessary hassles for legitimate physicians. He views the system as a success, but said it took time for CMS to integrate predictive analytics into Medicare’s traditional fraud-fighting methods, which included contractors focused on generating leads for law enforcement, not preventing fraud.
“It was not enough to identify fraud with the fraud prevention system. CMS needed to use that information effectively,” Budetti says.