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

Nursing home did not warn worker who was taken hostage in active ...

A nurse at a Life Care Centers of America facility in Colorado was not notified that she would be threatened and taken hostage by a gunman as part of an active shooter drill, according to a lawsuit filed Tuesday.

Revisions to False Claims Act urged by former deputy AG

A panel of witnesses debated the merits of the False Claims Act before a Judiciary subcommittee meeting Wednesday, with one former attorney general arguing current policy provokes unfair litigation and "coercive" settlements.

Medicare SNF rate finalized, reimbursements to increase by $750 million next year

Medicare SNF rate finalized, reimbursements to increase by ...

Medicare skilled nursing facility reimbursements will increase by $750 million next year under a final payment rule announced Thursday by the Centers for Medicare & Medicaid Services.