Corporate Compliance

Technology to help CMS identify potential fraud

Compliance Monitor, June 22, 2011

Starting July 1, CMS will begin using innovative predictive modeling technology to fight Medicare fraud, according to a CMS press release.

Medicare claims will be analyzed using a risk scoring technology similar to that used in the private sector to identify fraud.  The technology will allow CMS to identify potentially fraudulent Medicare claims before they are paid, CMS stated. With the new initiative CMS hopes to stop being a “pay and chase” provider and focus on preventing fraud and abuse on the front end.

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