Medicare contractors relying more on data analytics to investigate fraud

Although the number of fraud and abuse investigations initiated by Medicare benefit integrity contractors declined between 2012 and 2013, contractors leaned heavily on predictive analytics to identify fraudulent billing, according to a report released by the Office of Inspector General.

The report says that the number of proactive data analysis projects increased 62 percent from 2012 to 2013, which caused the percentage of fraud investigations that were derived from proactive leads to jump from 8 to 12 percent. Furthermore, the percentage of referrals from the Centers for Medicare & Medicaid Services' Fraud Prevention System more than doubled from 9 percent to 23 percent, while case referrals from law enforcement decreased 17 percent. Report