CMS Announces New Anti-Fraud Tool
The U.S. Centers for Medicare and Medicaid Services (CMS) announced that, starting July 1, it will start using predictive modeling technology to prevent fraudulent Medicare claims before they are paid. Northrop Grumman has been selected to develop this predictive model technology, in partnership with National Government Services (NGS) and Federal Network System, a Verizon company.
According to NAHC Report (6/20/11), "Predictive modeling creates a statistical model of future behavior and is used in forecasting probabilities and trends. The technology is similar to what credit card companies use and will be used as a tool by CMS to identify potentially fraudulent Medicare claims." The CMS press release (see June 17) states that Northrop Grumman "will deploy algorithms and an analytical process that looks at CMS claims - by beneficiary, provider, service origin or other patterns - to identify potential problems and assign an 'alert' and 'risk scores' for those claims. These problem alerts will be further reviewed to allow CMS to both prioritize claims for additional review and assess the need for investigative or other enforcement actions."