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

Double homicide at Houston nursing home; victims' roommate arrested

Double homicide at Houston nursing home; victims' roommate ...

A double murder occurred late Tuesday night in a Houston nursing home room shared by four men, according to local authorities. Police arrested Guillermo Correa on suspicion of beating two ...

$2 million HIPAA settlement highlights mobile device risks facing healthcare providers

Laptops and other mobile devices containing personal health information have been stolen from long-term care ombudsman programs and other healthcare organizations, including from Concentra Health Services and QCA Health Plan Inc. Now, Concentra and QCA have agreed to legal settlements totaling nearly $2 million, federal ...

Long-term care nurses often 'scramble' to get family members' blessing for palliative ...

Nursing home residents might not transition to full palliative care until they are very near death, at which point nurses and family members act in a state of crisis, suggests recently published research out of Canada.