CMS says new analytics are model for future fraud and abuse system

The Centers for Medicare and Medicaid Services intends to take a bigger bite out of fraud and abuse by strengthening its monitoring and analytics capabilities to prevent and detect suspicious activities. CMS will conduct enrollment and medical claims analytics using cutting-edge methods to keep the bad actors out of Medicare, share that information with Medicaid, and prevent the payment of fraudulent claims instead of chasing it down afterwards, said Peter Budetti, MD, CMS deputy administrator for program integrity. "This is the model for how the system is being put into place for Medicare and where we are going over time in Medicaid," he said Nov. 9 at the National Medicare RAC Summit.