A peek at what powers federal fraud detection

Congress recently learned how algorithms of the government's fraud prevention system (FPS) work, according to a blog post by attorney Deniza Gertzberg. Using the FPS led to actions against 938 providers in fiscal 2013, saving or preventing more than $200 million in overpayments. The FPS screens Medicare A and B claims against four analytical models before payment: A rule-based model reveals potential scams, such as billing under stolen identification numbers. An anomaly-based model searches for provider outliers. A predictive model compares current data to known fraud schemes. And a network-analysis model flags connections to bad-actor providers. Experts regularly revise the system to keep ahead of vulnerabilities, Gertzberg noted, and the FPS integrates other data sources (including hotline tips) to predict problems. Post

 

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