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Detecting Medicare Fraud

The Centers for Medicare and Medicaid Services announced in a press release dated June 17, 2011, that they will implement a new technology on July 1, 2011, to help in the fight against Medicare fraud.

The new technology uses “predictive modeling” and is likened to tools used by credit card companies to spot potential fraudulent activity quickly and respond in a timely manner. The technology will give CMS the ability to analyze behavior as it occurs and stop fraudulent payments before they are made. The analysis examines CMS claims by beneficiary, provider, place of service and other patterns.

Additional information on this new technology and other efforts to detect fraud and abuse can be found at www.HealthCare.gov/news/factsheets/fraud03152011a.html.

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