CMS Using New Technologies To Fight Healthcare Fraud

Nowadays State and Federal governments are focused on making healthcare fraud, waste and abuse their top priorities. In furtherance of this goal, the Centers for Medicare & Medicaid Services (“CMS”) announced recently that starting July 1, it will begin using innovative predictive modeling technology to fight Medicare fraud.

The agency will be using technology similar to that used by used by credit card companies to analyze suspicious activities. The goal is to use this predictive modeling to help identify potentially fraudulent Medicare claims on a nationwide basis.  CMS’ overarching aim is to stop fraudulent claims before they are paid.  According to CMS press release, this initiative builds on the new anti-fraud tools and resources provided by the Affordable Care Act that are helping move CMS beyond its former “pay & chase” recovery operations to an approach that focuses on preventing fraud and abuse before payment is made.