“The Centers for Medicare & Medicaid Services’ (CMS) Center for Program Integrity (CPI) has awarded a five-year, $34.4 million application programming interface (API) implementation contract that is set to boost data sharing for fraud detection.”
“The contract with health IT vendor CGI for its product API Gateway will create a streamlined, data sharing solution to advance CPI’s mission of exposing and combating fraud, waste, and abuse in the Medicare and Medicaid programs.”
“The health IT implementation will enable system users, such as law enforcement officials and the Office of the Inspector General (OIG), to access and analyze real-time data to expose Medicare and Medicaid fraud, waste, and abuse.”
“Access to such information is set to improve CMS CPI officials’ ability to proactively reduce waste and address fraud and abuse, which could potentially save CMS and taxpayers millions of dollars in unnecessary resources, CGI officials noted.”
“This is a major shift from the agencies previous ‘pay and chase’ model, where Medicare and Medicaid would routinely pay every bill and investigate cases only when it’s obvious that something is awry, CGI officials said.”
“’Implementing the API Gateway will enable real-time data sharing between Medicare and state Medicaid, while reducing redundant screening checks and operational costs,’ Steve Sousa, senior vice president of consulting services for CGI Federal, said in a public statement…” Read the full article here.
Source: CMS API Implementation Contract Boosts Data Sharing, Fraud Detection – By Hannah Nelson, August 25, 2021. EHR Intelligence.
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