HHS approves Florida Medicaid waiver to mine claims in search of fraud

Medicare and Medicaid fraud might as well be the unofficial state sport of Florida. After years of trying mostly in vain to rein in some of the criminal activity, Florida officials are going to try mining a Medicaid claims database to identify potentially fraudulent cases.

HHS earlier this month approved a Florida Medicaid waiver request for a demonstration program that will allow the Florida Medicaid Fraud Control Unit to mine the state's Medicaid Management Information System, which holds a database of electronic claims. State investigators will comb through claims activity and history in search of patterns and relationships that may represent fraud.

CMS currently prohibits state Medicaid anti-fraud units from using federal matching Medicaid funding to screen or review claims in search of abnormal activity. The Florida waiver allows the state to apply an unspecified amount of federal dollars to the data-mining program. 

"To fight healthcare fraud, we need to coordinate all of the resources and data we can muster," HHS Secretary Kathleen Sebelius said in a press release. "By allowing the state of Florida to use more information to find potential fraud in Medicaid, this waiver will improve Florida's ability to effectively identify and combat fraud and abuse."

For more information:
- read this Orlando Business Journal story
- see this HHS press release