VA, CMS Share Provider Enrollment Data to Combat Healthcare Fraud
The VA and CMS partnership to prevent healthcare fraud continues, with the departments now working together to protect veterans by identifying bad actors using Medicare provider enrollment data.
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By - CMS and the Department of Veterans Affairs (VA) recently announced a new data sharing initiative in which the departments will share provider enrollment data to prevent healthcare fraud, waste, and abuse.
“CMS is proud to work with VA and share our innovative data analytics and best practices for detecting and preventing potential fraud, waste, and abuse across other federal healthcare programs to improve care to our nation’s Veterans,” CMS Administrator Seema Verma stated in the announcement.
Specifically, the VA and CMS will exchange Medicare sanction data. Medicare sanctions is a provider for abusive medical billing practices, felony convictions, and improper prescribing habits, CMS explained in the announcement.
Through the sharing of Medicare sanction data, the VA hopes to prevent healthcare fraud, waste, and abuse before it happens to veterans. The VA will also adopt CMS protocols to approach healthcare fraud more “systematically.”
According to the report, the data exchange for Medicare Sanction is expected to transpire by the end of this year.
“CMS is an industry leader when it comes to identifying questionable providers and nefarious medical practices," VA Secretary Robert Wilkie, stated in the announcement. “Their willingness to partner with the VA puts Veterans first by allowing us to identify providers who do not meet our quality standards.”
The VA and CMS first announced their partnership in January 2018. The alliance shows VA’s commitment to seek out collaborations in order to recognize new and innovative ways to uncover fraud and abuse to “ensure every tax dollar is given to the VA supports Veterans,” said former VA Secretary Dr. David J. Shulkin at the time.
The VA is also looking to close any present gaps in its own claims payment process by using CMS’ integrity protocols and building off of them.
More recently, the VA has been held to strict reporting guidelines in order to understand staff shortage levels and patient access to care. According to the VA Office of Inspector General (OIG), recent findings have found that the agency is failing to oblige to these guidelines.
“VA has experienced chronic healthcare professional shortages since at least 2015,” OIG wrote in its report.
The VA has established a community care access program since the provider shortages and care access challenges started arising. They have also mandated the collection of staffing numbers, including staff losses, gains, and vacancies.
The department had been unsuccessful in meeting those guidelines. For example, they have not been clear about where they have staffing deficiencies, and fail to provide enough detail when listing staff vacancies, OIG found. The watchdog suggested that the VA improve the transparency of VA data releases.
However, a report from the Government Accountability Office (GAO) also recently found that the agency has been successful thus far in taking small steps towards increasing staffing levels. But, more recently, the agency issued guidance to its specific VA Medical Centers (VAMCs) to help them recruit and retain their own physicians.
Using state-of-the-art data analytics, VA and CMS are working together to better detect and prevent “wrongdoing in its programs.”
“We have a special obligation to keep America’s promise to those who have served our country and ensure that Veterans receive high-quality and accessible healthcare. CMS is sharing lessons learned and expertise to support VA to identify waste and fraud and eliminate these abuses of the public trust,” explained Verma.
