CMS to Adopt Predictive Fraud-Fighting Technology July 1

Beginning July 1, the Centers for Medicare and Medicaid Services will use a predictive modeling technology to combat Medicare fraud on a national basis, according to an agency announcement.

The technology is similar to that used by credit card companies and helps identify potentially fraudulent Medicare claims and stop them before they are paid. The agency says this is part of CMS' movement away from the "pay and chase" recover operations to an approach that focuses on fraud prevention. For the first time, CMS will be able to use real-time data to spot suspect claims.

Northrop Grumman, a global provider of advanced information solutions, has been selected to develop CMS' predictive technology format. Northrop Grumman will deploy algorithms and an analytical process that examines CMS claims by beneficiary, provider, service origin or other patterns. It will identify potential problems and assign an "alert" and assign "risk scores" for those claims.

Read the CMS announcement on its new anti-fraud technology.

Related Articles on Healthcare Fraud:
5 Recent Fraud Cases Involving Healthcare CEOs
12 Fraud and False Claims Cases Involving Physicians
10 Recent Stark, False Claims and Kickback Lawsuits Involving Hospitals and Health Systems


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