| 6311 Evaluation of the Effectiveness of the Operation Restore Trust Demonstrations |
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| Operation Restore Trust (ORT) was jointly developed by the Office of Inspector General (OIG), the Administration on Aging (AoA), and the Health Care Financing Administration (HCFA) as a model to demonstrate improved methods for investigation and prosecution of fraud and abuse in health programs. ORT targets a set of initiatives that focus on a few states, a few areas of the Medicare benefit, and a few standard operating procedures (especially, failures to coordinate among the most central agencies and to exploit available data resources). The report finds that: (1) ORT is associated with a net increase of more than 100 percent in ORT-type cases investigated by the Office of Investigation in DHHS' Office of the Inspector General (OIG); (2) these cases should generate substantial incremental receivables, some fraction of which will translate into true savings as collections are made; (3) HCFA and its contractors had a series of successful projects under ORT, with notably large collections or avoidances of payment accompanying many of these efforts although it cannot be said with certainty that these savings would not have been realized without ORT; (4) ORT encourages several important policy changes made during, or immediately following, the demonstration; (5) ORT may have important "sentinel effects" ( i.e., ORT may have deterred providers from certain kinds of suspect behavior); (6) there are considerable process effects of ORT; (7) giving the Administration on Aging a fraud and abuse mission led to active training, outreach, and education efforts; and (8) the infrastructure of information for combating fraud and abuse has significantly improved, although these improvements include many efforts outside ORT itself. The evaluation concludes that ORT turned around certain troubling trends of the early 1990's and has brought new vigor to government efforts to combat health care fraud and abuse. | |
| Project Officer: | Norwood, Edward |
| Centers for Medicare and Medicaid Services | |
| 410-786-6571 | |
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