Data-sharing's role in fraud detection


For healthcare fraud prosecutors, a key provision of the Affordable Care Act was the ability to access claims data from CMS.

This newfound reliance on real-time data revolutionized fraud enforcement efforts, says Gejaa Gobena, a partner with Hogan Lovells and the former deputy chief of the fraud section in the Justice Department’s criminal division.

Although a repeal of the ACA would wipe out those clarifications that facilitated data sharing capabilities, Gobena says that any new legislation that takes its place will likely include those functionalities.

“My suspicion is, the things that have helped improved antifraud efforts will somehow be preserved, whether by new legislation in replacement of the ACA, or the provisions that are kept if they decide to tinker with it,” he says.

Data-sharing's role in fraud detection

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