Federal Register #2026-21491

CMS and VHA program to match Medicare and VHA enrollment and claims records

HHS’s CMS and the VA’s VHA are establishing a program to match Medicare and VHA enrollment and claims records. - Government participants: Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), and the Department of Veterans Affairs (VA), through the Veterans Health Administration (VHA). - Program purpose: Identify people enrolled in both Medicare and VHA health care and detect claims where both agencies paid for the same services; use results to recover duplicate or improper payments, improve payment accuracy, and support fraud, waste, and abuse detection. - Records may include beneficiary identifiers and enrollment details, claims and service information, provider identifiers, diagnosis and procedure codes, and payment information. - No products, quantities, part numbers, commercial vendors, or OEMs are specified. This is a program notice, not a procurement request.

Description

HHS’s Centers for Medicare & Medicaid Services (CMS) is providing notice of a computer matching program with the Department of Veterans Affairs’ Veterans Health Administration (VHA). The program will identify beneficiaries enrolled in both Medicare and VHA health care and medical claims paid by both agencies for the same services. VHA will provide CMS with a recurring finder file, and the agencies will use matching results to recover duplicate payments, improve payment accuracy, and identify potential fraud, waste, and abuse. The program is scheduled to begin no sooner than 30 days after publication and remain in effect for 18 months, subject to the stated conditions for termination or renewal.

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