Tuesday, September 16, 2014

OIG Approves State MFCU Data Mining Applications

Dianne De La Mare

The US Department of Health and Human Services (HHS), Office of Inspector General (OIG) has recently approved state Medicaid Fraud Control Unit (MFCU) data mining applications in California, Michigan, Missouri and Oklahoma.

As reported previously, OIG published a final rule in May 2013, which amended a previous HHS regulation, to allow MFCUs to use federal matching funds to identify fraud through screening and analyzing Medicaid data (e.g., data mining). Data mining is defined in the rule as “…the practice of electronically sorting Medicaid or other relevant data, including but not limited to the use of statistical models and intelligent technologies, to uncover patterns and relationships within that data to identify aberrant utilization, billing, or other practices that are potentially fraudulent."

To obtain copies of the OIG approval letters and a copy of the OIG transmittal explaining the application process go to https://oig.hhs.gov/fraud/medicaid-fraud-control-units-mfcu/data-mining.asp.

No comments:

Post a Comment