HHS Announces New Tools to Detect Medicare Fraud
On June 17, the Department of Health and Human Services (“HHS”) unveiled a new initiative to detect potential fraud, waste, and abuse. Beginning July 1, 2011, the Centers for Medicare and Medicaid Services (“CMS”), along with the HHS Office of Inspector General (“OIG”) will begin “real-time” data mining of Medicare claims.
The agencies will use predictive modeling technology that analyzes claims data to identify Medicare claims that may be fraudulent. The technology is similar to that used by credit card companies to identify fraudulent transactions.
This initiative is the most recent addition to a growing arsenal of fraud, waste, and abuse enforcement tools funded by the HITECH Act and Health Reform Law.