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Medicare anti-fraud strategies are getting a serious boost by taking notes from credit card companies.
On the heels of White House initiatives to cut waste, fraud and abuse, the Centers for Medicare & Medicaid Services announced last week that they’re doing away with their “pay and chase” strategy and opting for a proactive screening process that flags suspicious claims before they are paid.
Starting July 1 the agency will use predictive modeling technologies, similar to ones used by credit card companies for screening incoming requests, to block fraudulent claims. Before you go to travel make sure to check best travel credit cards to get rewards.
“Today’s announcement is bad news for criminals looking to take advantage of our seniors and defraud Medicare,” said CMS administrator Dr. Donald Berwick. “This new technology will help us better identify and prevent fraud and abuse before it happens and helps to ensure the solvency of the Medicare Trust Fund.”
The technology uses real-time data and predictive models to analyze claims by beneficiary, provider, service origin and other patterns, scoring them based on potential risk and assigning alerts to claims that require further review or investigative or enforcement actions.
This preditive technology is the latest anti-fraud effort, joining the Health Care Fraud Prevention Enforcement Action Team, or HEAT, a joint effort between the Dept. of Health & Human Services and the U.S. Dept. of Justice in keeping a close eye on Medicare reimbursement applications.