On Monday, October 21, 2019, the Centers for Medicare & Medicaid Services (CMS) posted a request for information (RFI) soliciting comments on the use of new technologies in the Medicare and Medicaid programs. In a blog post accompanying the release of the RFI, CMS Administrator Seema Verma referenced the Government Accountability Office’s designation of “Medicare as a High Risk program since 1990 because of its size, complexity and susceptibility to improper payments.”  She also noted that last year improper payments accounted for 5% of Medicare’s total net costs.

In the RFI, CMS states that it believes it can “learn from the forwarding-thinking tools utilized by the private sector.”   CMS hopes to obtain information from the private sector on applying next-generation tools and technologies to its programs in an effort to help CMS:

(i) identify legitimate providers and suppliers upon an initial screening and continuous monitoring;

(ii) continually encourage the advent of electronic health records by creating a more seamless system across all platforms and payors;

(iii) create a system where current and historic data systems that CMS has work together;

(iv) use new, more efficient tools to monitor claims;

(v) change how CMS currently handles audits; and

(vi) potentially improve its education of providers and suppliers on how to follow Medicare requirements.

One example of a new technology tool that CMS states that it could potentially use is an “easy, seamless” system that gives it “access to state and local business ownership and registration information that could improve CMS’ line-of-sight to potentially problematic business relationships.”

Comments must be submitted to CMS by November 20, 2019, and they must be submitted electronically to: AlProgramIntegrityRFI@cms.hhs.gov.

*Special thanks to Hayley White, Law Clerk and District of Columbia Bar license pending, for her assistance in preparing this post.