CMS to Tap Tech for Medicare Fraud Fight
Northrop Grumman was selected through a competitive procurement to develop CMS' national predictive model technology format using best practices of both public and private stakeholders. The contract is being implemented nationally and ahead of schedule.
Northrop Grumman will deploy algorithms and an analytical process that looks at CMS claims – by beneficiary, provider, service origin or other patterns — to identify potential problems and assign an "alert" and assign "risk scores" for those claims. These problem alerts will be further reviewed to allow CMS to both prioritize claims for additional review and assess the need for investigative or other enforcement actions, CMS said.
John Commins is a senior editor with HealthLeaders Media.
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