CMS fights fraud with predictive modeling

In a continuing fight against fraudulent claims, the Centers for Medicare & Medicaid Services is relying more heavily on predictive modeling, reported The Washington Post.

CMS has retained aerospace giant Northrup Grumman and TurningPoint to move the agency past the longtime practice of "pay and chase"--trying to recoup crooked claims after they have been paid, noted the article.

Altogether, less than 5 percent of healthcare fraud is detected, according to Government Health IT. Most of that is occurring close to or after payments are made, and little of the money gets recovered.

Northrup Grumman is providing a predictive modeling system to better identify those providers submitting fraudulent claims, while TurningPoint is being used to identify providers that are not eligible to participate in Medicare, according to the Post. CMS' new fraud prevention approach uses a variety of criteria to identify suspect providers, including criminal and credit histories.

To learn more:
- read the Washington Post article
- here's the Government Health IT article

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