The Centers for Medicare & Medicaid Services (CMS) announced that starting July 1, it will begin using a new predictive modeling technology to fight Medicare fraud. Similar to technology used by credit card companies, predictive modeling helps identify potentially fraudulent Medicare claims on a nationwide basis, and help stop fraudulent claims before they are paid. This initiative is designed to build upon anti-fraud tools and resources provided by the Affordable Care Act to help move CMS beyond its former “pay & chase” recovery operations to an approach that focuses on preventing fraud and abuse before payment is made.
“Today’s announcement is bad news for criminals looking to take advantage of our seniors and defraud Medicare,” said CMS Administrator Donald Berwick, M.D. “This new technology will help us better identify and prevent fraud and abuse before it happens and helps to ensure the solvency of the Medicare Trust Fund.”
More information on the predictive modeling and HHS’ effort to detect fraud and abuse are available at www.HealthCare.gov/news/factsheets/fraud03152011a.html and through its news portal at www.HealthCare.gov, made available by the US Department of Health and Human Services.
Source: CMS Press Release