NC fights Medicaid fraud with analytics

InformationWeek, May 25, 2012

States budgets are under pressure, and Medicaid funding is often among the hardest hit. But in some states, including North Carolina, data analytics software is helping to uncover millions of dollars in potential savings through the detection of fraudulent Medicaid billing. North Carolina's department of health and human services began collaborating with IBM in 2010 to develop analytics to help identify suspicious billing patterns by healthcare providers. To date, North Carolina has identified $191 million in potentially false Medicaid claims by 206 outpatient behavioral health providers in the state.


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