HCFA's dallying costing millions as fraud continues
HCFA’s dallying costing millions as fraud continues
The Health Care Financing Administration (HCFA) has failed miserably in its attempt to develop a computer system to help combat Medicare fraud and abuse and wasted millions of dollars in the process, the U.S. General Accounting Office (GAO) says.
Testifying before the House of Representatives’ Subcommittee on Oversight and Investigations and the Committee on Commerce, Joel C. Willemssen, GAO Director of Information Resources Management Accounting and Information Management Division, told committee members that almost four years and $80 million after launching an effort to develop the so-called Medicare Transaction System (MTS), HCFA has nothing to show for its efforts.
MTS was scrapped in August because of schedule delays, cost overruns, and lack of effective management and oversight.
"What has the money purchased?" Willemssen asked. "A huge learning experience about the difficulty of acquiring such a large system under a single contract and a better understanding of the requirements for developing a Medicare claims processing system, but no integrated claims processing software to aid HCFA in preventing fraud and abuse."
In January 1994 HCFA announced a plan to develop one unified system to improve the efficiency and effectiveness of Medicare claims processing and address the problems of fraud and abuse. The plan aimed to replace the three computer systems used to process Medicare Part A claims and the six computer systems to process Part B claims with one system.
Cost overruns drove estimated project costs from $151 million in 1992 to about $1 billion in 1997. The MTS termination, Willemssen said, "delays one means of possibly combating fraud and abuse."
Other HCFA information technology initiatives will continue however: analyzing the potential for using existing commercial software and exploring the possibility of developing its own anti-fraud software. But, Willemssen reported, "any positive results from this testing are not expected to be implemented nationally for at least several years. In the meantime, hundreds of millions of dollars continue to be lost annually, some of which could have possibly been saved with timely implementation of this software."
A fiscal 1996 audit of Medicare fee-for-service payments by the Office of the Inspector General found $23.2 billion in overpayments, which could range from inadvertent mistakes to outright fraud and abuse.
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