CMS Revises Medicare Program Integrity Manual: Work of Program Safeguard Contractors And Data Mining Fully Implemented

The Centers for Medicare and Medicaid Services (CMS) issued revised Medicare Program Integrity (PIM) instructions, effective May 10, 2004, via Transmittal 71 (April 9, 2004).  The revisions may be accessed online at www.cms.hhs.gov/manuals/transmittals/comm_date_dsc.asp.  The revisions to the PIM are significant because they are a final step in implementing the transition of fraud case development and law enforcement support work from Medicare carriers and fiscal intermediaries to Program Safeguard Contractors (PSCs).  The discovery of alleged Medicare program billing abuse in connection with Medicare claims involving power wheelchairs underscored the need for updating the PIM to instruct PSCs to undertake more intensive data mining projects.  The revised PIM also has provisions facilitating data sharing with Medicaid agencies.