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ExpectMore.govExpectMore.gov home pageEXPECT FEDERAL PROGRAMS TO PERFORM WELL, AND BETTER EVERY YEAR.
 
Program Assessment

Program

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Medicare Integrity Program

The Medicare Integrity Program is the Centers for Medicare & Medicaid Services primary program for safeguarding the Medicare Trust Funds against fraud, waste and abuse. The program conducts reviews and investigations of Medicare expenditures to ensure Trust Fund resources are properly utilized for the program's mission.

Rating

What This Rating Means

PERFORMING
Effective

This is the highest rating a program can achieve. Programs rated Effective set ambitious goals, achieve results, are well-managed and improve efficiency.
  • The program relies on performance measures, such as the Medicare error rate, that are directly relevant to its purpose. The Medicare Modernization Act significantly expanded CMS's responsibilities and will require an additional program integrity activity.
  • The program has established quantitative performance measures and baseline against which performance is measured.
  • Prior to contracting reform, CMS claims processing contractors' payment did not include incentives to reduce payment errors. Thus, contractors' reimbursement is on a cost basis and is unaffected by the number of claims payment errors made.

Improvement Plan

About Improvement Plans

We are taking the following actions to improve the performance of the program:

  • Developing and implementing safeguards to protect the Medicare Advantage program and the Medicare Prescription Drug Benefit against fraud, waste, and abuse.
  • Implementing contracting reform authority to move claims-processing contractors to contracts based, in part, on error rate reduction.
  • Refining the comprehensive error rate testing program (CERT) process to increase the detail of CERT error rates.

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