Coalition Member Weighs in on PRIME Act


HMS, a Proper Payments coalition member, sent the following letter to Reps. John Carney (D-Del.) and Peter Roskam (R-Ill.) in support of the Preventing Improper Medicare & Medicaid Expenditures (PRIME) Act.


Dear Representatives Carney and Roskam:

As a leader in cost containment and program integrity services for government healthcare programs, HMS is honored to support the Preventing Improper Medicare & Medicaid Expenditures (PRIME) Act, which aims to curb waste, fraud, and abuse in Medicare and Medicaid programs.

HMS has nearly 30 years of experience supporting healthcare programs, and we currently help 45 state Medicaid agencies and the Medicare program contain costs and ensure claims are paid accurately and correctly. HMS is part of the Medicaid RAC solution in 30 states and, through our wholly owned subsidiary HDI, is a successful Medicare Recovery Audit Contractor (RAC). We also partner with Zone Program Integrity Contractors and perform work for the Centers for Medicare and Medicaid Services Medicaid Integrity Program. In 2012 HMS recovered over $3.0 billion in cash for these programs and prevented billions more from being improperly paid as a result of our cost avoidance work. Our position grants us a unique perspective into the world of waste,fraud, and abuse and allows us to predict with a high degree of certainty that the PRIME Act will substantially aid program integrity efforts.

HMS commends several provisions of the PRIME Act including language revolving around data sharing and program improvement. As a contractor for both the Medicare and Medicaid program we understand coordination is a key to program integrity. Sharing actionable Medicare claims data with Medicaid agencies for the purpose of reviewing care and claims for dual eligible recipients can be very effective in both identifying overpayments and ensuring quality of care. Additionally, allowing a portion of the federal share of funds recovered by Medicare RACs to go toward investigations and provider education is a strong idea. Because Medicare RACs return a substantial amount of money to the federal government, over $480 million during fiscal year 2011 alone, the PRIME Act will allow for an influx of funds for provider education and investigations. This will help curb current waste, fraud, and abuse and build the appropriate framework for future program integrity strengthening efforts.

Thank you both for your efforts to bolster program integrity within Medicare and Medicare through the PRIME Act. HMS appreciates the opportunity to offer our support for the bill and looks forward to working with you both to explore new ways to power healthcare with integrity.


Bill Lucia
Chief Executive Officer

Access the original letter here.

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