CMS announces Medicare fraud and abuse initiative

Share this article:

Those who commit Medicare fraud and abuse are facing a new foe: better technology.

The Centers for Medicare & Medicaid Services announced Friday a new initiative, effective July 1, that uses a predictive modeling technology used by credit card companies that can identify potentially fraudulent claims before they are paid. To implement this nationally, CMS has contracted with Northrop Grumman, which has partnered with National Government Services and Federal Network Systems. The initiative aims to replace CMS' current “pay and chase” fraud recovery operation.

According to CMS, Northrop Grumman uses algorithms and an analytical process that analyzes CMS claims by beneficiary, provider, service origin or other patterns to identify and send alerts of potential problems.

“Predictive modeling is a revolutionary new way to detect fraud and abuse, integrating effective and timely actions with protections and savings for Medicare and taxpayers,” said Peter Budetti, M.D, J.D., director of CMS' Center for Program Integrity.

Share this article:

More in News

Long-term care continues to lead in deal volume and value: PwC report

Long-term care continues to lead in deal volume ...

Long-term care bucked healthcare industry trends with strong merger and acquisition activity in the second quarter of 2014, according to newly released data from professional services firm PricewaterhouseCoopers.

Empowering nurse practitioners could reduce hospitalizations from SNFs, study finds

Granting more authority to nurse practitioners is associated with reduced hospitalization of skilled nursing facility residents, according to recently published findings.

Pioneer ACO drops out of program, despite reductions in skilled nursing utilization

A California healthcare system has become the latest dropout from the Pioneer Accountable Care Organization program, despite reducing skilled nursing facility utilization and improving its readmission rates. Sharp HealthCare announced its decision in a quarterly financial statement released Tuesday.