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Feds: Medicare, Medicaid fraud risk assessment needed

In a fact sheet released last year, the Obama administration touted its efforts in "reducing fraud, waste, and abuse across the government." But many observers believe the federal government still isn't doing enough to prevent fraud in Medicare and Medicaid.

The Government Accountability Office said in a recent report that a fraud risk assessment is needed to evaluate those publicly funded programs and determine which parts of each are at highest risk of fraud. The report was prepared for a group of eight U.S. senators and members of the House of Representatives, including Congressman Kevin Brady of Texas.

The Centers for Medicare & Medicaid Services apparently struggles to fight fraud because of its low budgets and lack of fraud risk assessments, Bloomberg reports.

Private insurance companies typically allocate six percent or more to administrative budgets that include fraud prevention efforts. The CMS gets less than 2 percent for administrative costs, which means “It’s not surprising that CMS hasn’t been able to execute an effective and comprehensive fraud prevention plan,” a Bloomberg legal analyst said.

The chief executive officer of the National Health Care Anti-Fraud Association said despite budgetary constraints and lack of risk assessment process, the CMS allocates resources to fraud-related problems that develop in the programs it manages. What's lacking, he said, is an approach that anticipates problems before they manifest themselves.

The CMS says it plans to conduct a Medicare and Medicaid fraud risk assessment once a fraud risk assessment of the Affordable Care Act marketplace is completed.

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