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The Centers for Medicare & Medicaid Services Could Improve Performance Measures Associated With the Fraud Prevention System

We found that CMS's process for refining and enhancing FPS models needs improvement. Specifically, CMS could not track savings from administrative actions back to the individual FPS models that initiated the investigation because, according to CMS, that capability was not built into the FPS. In addition, CMS did not make use of all pertinent performance results because CMS did not (1) ensure that the adjusted savings Zone Program Integrity Contractors (ZPICs) and Program Safeguard Contractors (PSCs) reported to CMS reflected amounts certified by the OIG and (2) evaluate FPS model performance on the basis of the amounts actually expected to be prevented or recovered (i.e., adjusted savings). As a result, the FPS is not as effective in preventing fraud, waste, and abuse in Medicare as it could be.


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