HHS program integrity director Peter Budetti is a man excited about the possibilities of anti-fraud software, data mining/screening and analytics, according to a lengthy feature on healthcare fraud in Reuters yesterday. He says they'll not only catch con artists, but also prevent fraudulent payments from even being made.
"We will be able to run every (billing) claim through advanced technology screening by the middle of next year. Every claim will be subjected to a wide range of analytics all of the time and it will be a system that learns on top of itself," Budetti tells the news site. The department is working on risk-screening for new Medicare suppliers, the ability to automatically stop payments to suspected crooks and software to sniff for patterns of fraud.
Industry watchers and anti-fraud experts tell Reuters they are skeptical of a technology-heavy approach. They point to previous tech-based anti-fraud efforts, such as neural networks a decade ago, that they say proved ineffective.
Opponents' general take on the fraud situation in Washington: Technology is useful, but the system needs better law enforcement, more aggressive investigations and longer sentences for criminals when they're caught. "I'm not sure it's a winnable war without putting more money into investigators," says Patrick Burns, of Taxpayers Against Fraud, notes Reuters. "The truth is that CMS doesn't have the resources and investigators to go out and rodeo all the fraud. It just doesn't."
In one startling statistic, Malcom Sparrow of Harvard University's Kennedy School of Government says that the government would need to stop $100 million worth of billing scams each day just to "put a serious dent" in today's fraud problem.
Right now, "we're seeing about one every two months," he reveals.
The Reuters article does point out that 2010 was a banner year for anti-fraud efforts, according to government statistics, which show $4 billion recovered last year.
To learn more:
- check out the Reuters article
- learn more about HHS' electronic anti-fraud tools