Medicare agency targets fraud and abuse prevention

The Obama administration will invest in new technology to prevent wasteful and fraudulent payments in federal health programs, officials said Thursday.

The Centers for Medicare and Medicaid Services will issue a solicitation for fraud-fighting analytic tools to help the agency predict and prevent potentially improper payments before they occur, Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder announced during a healthcare fraud prevention summit in Boston.

HHS said it is exploring systems similar to the predictive modeling tools used by banks and other companies to identify potential fraud before it occurs. The technology will help CMS prevent bad actors from enrolling as care providers or suppliers, HHS said.

CMS said it is already starting to take administrative action to stop fraudulent payments before they are made, instead of chasing down payments after they have been made.

“By using new predictive modeling analytic tools we are better able to expand our efforts to save the millions — and possibly billions — of dollars wasted on waste, fraud and abuse,” CMS Administrator Donald Berwick said in a statement.

The new healthcare reform law also provided an additional $350 million over the next 10 years to fight fraud and abuse. It also toughens sentencing for criminal activity, enhances screening and enrollment requirements and expands overpayment recovery efforts.