Data drives historic fraud takedown

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Federal officials are highlight streamlined data analysis as the critical factor in last week’s historic fraud bust that resulted in the arrests of 301 people who are accused of being involved in schemes worth $900 million.

For years, authorities had been chasing Aleksandr Pikus, who was charged with orchestrating a kickback scheme in New York involving more than $86 million in false claims submitted to Medicare, according to Marketplace. But over the last several years, investigators were able to build a better case against Pikus using real-time billing data.

“In the past, when we didn’t have the kind of computing capability that we do now. Trying to determine a national scope, could take weeks, months, sometimes even years,” Ann Maxwell, assistant inspector general at the Department of Health and Human Services (HHS) Office of Inspector General (OIG) told Marketplace. “Now we are talking about a couple of hours.”

The OIG expects to add 10 new staff members this year who will report to Chief Data Officer Caryl Brzymialkiewicz, according to the news outlet, and requests for data from investigators have increased considerably. A day after the government announced the coordinated takedown, Brzymialkiewicz called data the “unsung hero,” according to Nextgov.com.

Brzymialkiewicz also highlighted the increasingly collaborative relationship between OIG investigators and data analysts in an interview with Bloomberg BNA. She added that the agency is focusing on the development of data-driven tools such as the peer comparison generator, which presents data that is visually compelling and easy to interpret.

“Something else we’re really working toward is how do we help people see in the information in a way that’s meaningful to them,” she said.

Brzymialkiewicz expressed similar sentiments last year, indicating analytics served as a major tool in a 243-person, $712 million fraud bust. Increasingly, healthcare payers are using  predictive analytics to identify sophisticated schemes that have gone undetected in the past. Last month, the Centers for Medicare & Medicaid Services announced that the agency’s Fraud Prevention System saved more than $1 billion in improper payments over the last two years.

To learn more:
- read the Marketplace article
- here’s the Nextgov.com article
- watch the Bloomberg BNA video