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Feds Seek Anti-Fraud Technologies to Nab Medicare Cheats

Cheryl Clark, for HealthLeaders Media, December 17, 2010

The Obama Administration is looking for sophisticated fraud-fighting tools which could enable federal agencies to catch illegal Medicare and Medicaid practices as they happen.

"Many companies in the private sector, as well as the Centers for Medicare and Medicaid Services, have been testing and using predictive modeling programs to help identify possible fraudulent providers and scams based on historical information about the individual or the company in which the individual is affiliated," the Health and Human Services Agency said in a statement.

As an example, the HHS said, CMS has already taken action to stop federal payments to so-called "false fronts" in Texas identified through sophisticated predictive modeling.

HHS secretary Kathleen Sebelius and Attorney General Eric Holder made their comments at the fourth regional healthcare fraud prevention summit on Thursday at the University of Massachusetts in Boston.

As part of that summit, CMS said it is soliciting "state-of-the-art fraud fighting analytic tools to help the agency predict and prevent potentially wasteful, abusive or fraudulent payments before they occur." The tools would be used by the National Fraud Prevention Program as well as the Department of Justice Health Care Fraud Prevention and Enforcement Action Team (HEAT).

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