Tuesday, July 21, 2015

CMS Fraud Prevention System

Qingping Wang

The US Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS) reports that its Fraud Prevention System identified or prevented $820 million in improper Medicare payments in the first three years.

In 2014 alone, the system identified or prevented $454 million, a 10 to 1 return in investment for the federal government. The Fraud Prevention System uses predictive analytics to identify troublesome billing patterns and outlier claims for action, similar to systems used by credit card companies.

CMS plans to expand the Fraud Prevention System and its algorithms to identify lower levels of noncompliant health care providers who would be better served by education or data transparency interventions.

To read the press release and the entire report go to http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2015-Press-releases-items/2015-07-14.html.

No comments:

Post a Comment