Full access
Government News
Published Online: 5 August 2011

New Technology Expected to Slash Medicare Fraud

Jonathan WolfeAuthors Info & Affiliations
Publication: Psychiatric News
Volume 46, Number 15
https://doi.org/10.1176/pn.46.15.psychnews_46_15_12_3

Abstract

CMS hopes to reduce the number of payouts on bad Medicare claims with the introduction of new technology designed to root out scam artists who abuse the health program.
New predictive modeling technology will aid in the fight against fraudulent Medicare claims, announced Health and Human Services Secretary Kathleen Sebelius and U.S. Attorney General Eric Holder at the sixth regional Health Care Fraud Prevention Summit held in Philadelphia on June 17.
This innovative approach to identifying health care system abuses is the latest weapon in the antifraud arsenal developed under the Patient Protection and Affordable Care Act, the health reform law enacted last year. Proponents of the technology tout its ability to prevent fraud prior to payment on Medicare claims, which will help the Centers for Medicare and Medicaid Services (CMS) limit reliance on its current "pay-and-chase" recovery process.
"These are the same type of ... tools that banks and insurance companies use to identify potential fraud," Sebelius said. "They are how your credit-card company can raise the alarm if [it sees] a dozen flat-screen televisions charged to your card in one day."
According to CMS, the "risk-scoring" technology will analyze fee-for-service Medicare claim patterns via identifying information such as beneficiary, provider, and service origin. Any claims identified as potentially problematic will be evaluated and prioritized for further review, leading to investigative or other enforcement action as necessary.
CMS has awarded a one-year, $77-million contract for the new Medicare fraud-detection system to Northrop Grumman in partnership with National Government Services and Verizon's Federal Network Systems.

Information & Authors

Information

Published In

Go to Psychiatric News
Psychiatric News
Volume 46 • Number 15 • August 5, 2011
Pages: 12

History

Published online: 5 August 2011
Published in print: August 5, 2011

Authors

Details

Metrics & Citations

Metrics

Citations

Export Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.

For more information or tips please see 'Downloading to a citation manager' in the Help menu.

Format
Citation style
Style
Copy to clipboard
Tips for downloading citations

There are no citations for this item

View Options

View options

Get Access

Login options

Already a subscriber? Access your subscription through your login credentials or your institution for full access to this article.

Personal login Institutional Login Open Athens login

Not a subscriber?

Subscribe Now / Learn More

PsychiatryOnline subscription options offer access to the DSM-5-TR® library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Media

Figures

Other

Tables

Share

Share

Share article link

Share

×

As described within the American Psychiatric Association (APA)'s Privacy Policy and Terms of Use, this website utilizes cookies, including for the purpose of offering an optimal online experience and services tailored to your preferences. Please read the entire Privacy Policy and Terms of Use. By closing this message, browsing this website, continuing the navigation, or otherwise continuing to use the APA's websites, you confirm that you understand and accept the terms of the Privacy Policy and Terms of Use, including the utilization of cookies.