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.
- Half of All Primary Care, Internal Medicine Jobs Unfilled in 2013
- How Digital Strategy Shapes Patient Engagement at Boston Children's Hospital
- CFO Exchange: Smartphones Poised to Disrupt Healthcare, Says Topol
- CNO on Hospital Redesign: 'You Can't Over-Communicate'
- Some Cancer Hospitals' Quality Data Will Soon Be Public
- CA Powers Up $80M HIE to 'Create Value in the Data'
- TJC Warns Hospitals of Deadly Medical Tubing Mistakes
- 3 Traits Personality Assessments Can't Reveal
- PA Ranks See 'Phenomenal Growth,' Lack of Diversity
- Consumerism Drives Healthcare Branding, Rebranding Efforts