Nov 10, 2014
From the Government Institute
With the Affordable Care Act (ACA), our nation’s healthcare system is undergoing historic change. An important component of the law is reducing healthcare fraud, waste, and abuse. For fiscal year 2013, federal agencies reported an estimated $106 billion in improper payments. Of those, $65 billion (or 60 percent) were reported by the Department of Health and Human Services (HHS), primarily attributable to Medicare and Medicaid.
Title VI of the ACA contains what have been referred to as the strongest healthcare anti-fraud provisions in American history. The ACA provides new tools to fight healthcare fraud, protect consumers, and safeguard taxpayer dollars. It calls for strengthened processes and internal controls, such as requiring screening of healthcare providers and suppliers based on risk; shifting the payment focus from “pay and chase” to prevention; and strengthening sanctions and law enforcement capabilities.
This KPMG Government Institute Issue Brief discusses how financial managers at all levels of government have a huge opportunity to bring their knowledge, skills, and abilities to bear in helping program managers implement the ACA’s program-integrity provisions.