The U.S. Department of Health and Human Services (DHHS) and the Centers for Medicare and Medicare Services (CMS) recently released its – Annual Report to Congress on the Medicare and Medicaid Integrity Programs For Fiscal Years 2013 and 2014.
The biggest and most important take-away from the report – the government achieved “… a two-year average return on investment of 12.4 to 1 for the period that ended on September 30, 2014.”
Program integrity and fraud fighting efforts by DHHS and CMS have consistently represented a significant return on investment for the government. This is likely the single biggest reason why providers have not seen any serious reduction in program integrity efforts and fraud fighting enforcement over at least the last 10 years. With this type of ROI, the US government is, unfortunately, only likely to find more ways to fund and carry out program integrity efforts and enforcement.
Providers and suppliers need to continue to focus resources on regulatory compliance to the best of their abilities and hope that they don’t invite unwarranted program integrity scrutiny.