Restructure Will Happen Before CMS Gets a New Chief

The Centers for Medicare & Medicaid Services (CMS) is being restructured, despite lacking a Senate-confirmed administrator since the last one stepped down October 2006. The new structure adds a new pricipal deputy administrator, reporting directly to Acting CMS Administrator Charlene Frizzera. Firzzera announced the changes Feb. 16 via an e-mail sent to agency staff, and apparently expects the changes to happen by mid-April. The changes were expected to be approved by HHS Secretary Kathleen Sebelius.

The new office is the Center for Program Integrity (CPI) will combine the Medicare Program Integrity Group of the Office of Financial Management and the Medicaid Integrity Group of the Center for Medicaid and State Operations. CPI will be led by newly hired Peter Budetti, MD. Dr. Budetti is considered a leading expert on health care fraud and has directed health administration and policy departments at three leading universities since 1990, according to Frizzera.

The Center for Program Integrity will absorb some Medicare and all of the Medicaid program integrity operations. Kim Brandt, the longtime director of program integrity, will become part of the Center for Program Integrity. She is in charge of the zone program integrity contractors (ZPICs), which focus on fraud and abuse and enrollment. The Medicaid Integrity Group will be located in the Center for Program Integrity. However, the Provider Compliance Group will not move over to the new Center for Program Integrity, but will instead remain under the Center for Financial Management, which will become part of the new Center for Medicare, another newly created center within the new Office of External Affairs and Beneficiary Services. George Mills will continue to be the director of the Provider Compliance Group, which oversees recovery audit contractors (RACs), medical review, and comprehensive error rate testing (CERT). The emphasis of the Provider Compliance Group is on payment-error prevention and detection and error-rate calculation.

The creation of a new center that includes program integrity, with direct-line reporting to the CMS administrator, is seen as significant. Program Integrity has just been bumped up the ladder, with access to more resources and more importance.