CMS Employs New Technology to Fight Medicare Fraud

The Centers for Medicare & Medicaid Services (CMS) on July 1 will roll out an initiative to crack down on waste, fraud and abuse, it announced. Using predictive modeling technology similar to technology used by credit card companies, it aims to identify and stop potentially fraudulent Medicare claims before they are paid.

The initiative will build on the new anti-fraud tools and resources provided by the Affordable Care Act that are helping to move CMS beyond its former “pay and chase” recovery operations to an approach that focuses on prevention.

To implement the program, CMS will work with Northrop Grumman, a provider of advanced information solutions, which has partnered with National Government Services and Federal Network Systems.

Original Medicare forms will be analyzed using risk scoring technology that applies predictive models, an approach similar to that used by the private sector to identify fraud. For the first time, CMS will have the ability to use real-time data to spot suspect claims and providers and take action to stop fraudulent payments before they are paid, it said.