CMS fights fraud in new drug program

The Centers for Medicare and Medicaid Services has selected eight Medicare Rx Integrity Contractors to uncover fraud, waste and abuse in the new Medicare prescription drug program that takes effect Jan. 1, 2006. Enrollment for the benefit begins Nov. 15.

The vendors chosen earlier this month will compete for task orders under the master contract to analyze data to reveal problems that may indicate fraud or abuse, and investigate potentially fraudulent activities related to enrollment, eligibility and distribution of the prescription drug benefit. They may also develop and refer cases to the appropriate law enforcement agency if needed.

The eight contractors are:
  • Delmarva Foundation for Medical Care Inc. of Easton, Md.

  • EDS Corp. of Plano, Texas

  • IntegriGuard LLC of Omaha, Neb.

  • Livanta LLC of Annapolis Junction, Md.

  • Maximus Federal Services Inc. of Reston, Va.

  • NDCHealth of Atlanta

  • Perot Systems Government Services Inc. of Alexandria, Va. and

  • Science Applications International Corp. of San Diego.

EDS gets task order

In separate but related news, CMS also awarded EDS a task order to serve as the Region D Program Safeguard Contractor for Durable Medical Equipment, such as oxygen tanks and hospital beds.

The contract contains a five-month transition, followed by an eight-month operational period with four one-year options. It has a potential value of $34.5 million if all options are exercised. Region D is comprised of 17 Western states, Guam, the Mariana Islands, and American Samoa.

EDS will lead a team comprised of IntegriGuard, Fair Isaac Corp. of Minneapolis, Overland Solutions Inc. of Overland Park, Kan., and Dynamics Research Corp. of Andover, Mass., to analyze data, identify fraudulent claims and reduce the error rate for billed claims.

EDS currently provides Medicare benefit integrity services and fraud detection in California, Connecticut, Florida, Maine, Massachusetts, New Hampshire, Rhode Island, New York, New Jersey, Pennsylvania, Vermont, Puerto Rico and the U.S. Virgin Islands. It also matches Medicare and Medicaid data in California, New Jersey, New York and Pennsylvania, to find potential fraudulent billings in both programs.

About the Author

Mary Mosquera is a reporter for Federal Computer Week.

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