Industry News

CMS and VA Announce Partnership to Address Fraud, Waste, and Abuse.

The Department of Veterans Affairs (VA) and the Centers for Medicare & Medicaid Services (CMS) recently announced a partnership designed to prevent and identify fraud, waste, and abuse.  The Veterans Health Administration, a large integrated health care system operated by the VA, faces significant issues that CMS has already attempted to address.  The Veterans Health Administration operates an integrated network of 168 medical centers, over 1,000 outpatient clinics, 250 brick-and-mortar pharmacies, and 7 mail-order pharmacies.  The VA is itself a provider through the Veterans Health Administration, employing over 200,000 healthcare professionals and providing healthcare to roughly 9 million veterans in the US.

The CMS and VA partnership seeks to enhance ongoing efforts between the country’s two largest public-private healthcare payment organizations.  CMS and the VA will share data, data analytics tools, and best practices for detecting and preventing fraud, waste, and abuse.  Both organizations will work to identify new and innovative ways to recover improper payments.  CMS’s program integrity activities saved Medicare operations an estimated $17 billion in fiscal year 2015, and CMS hopes that focus on the VA will yield similar successes.  CMS plans to share new practices and technologies that will enable the VA to remediate existing gaps in its own claims payment processes.  CMS also noted in the partnership announcement that in November 2017, the VA invited industry experts to provide information on the latest commercial sector tools and techniques to enhance the VA’s fraud detection capabilities.

The CMS press release is available at: