CMS Announces New Technology to Identify Medicare Fraud
The Centers for Medicare & Medicaid Services (CMS) announced today that it will begin using predictive modeling technology to identify and fight Medicare fraud.
Northrop Grumman, through a partnership with National Government Services and Federal Network Systems (a Verizon company), will develop the predictive modeling technology. The technology will use algorithms and an analytical process to look at CMS claims – by beneficiary, provider, service origin, or other patterns – in order to identify potential problems and assign “alerts” to problematic claims. CMS staff will conduct further review of alerts to prioritize claims and assess the need for investigation or enforcement actions.
CMS will begin using the new technology on July 1.