Senate Finance Committee Chairman Max Baucus (D-Mont.) on Tuesday unveiled modifications to his small-business package that includes almost $1 billion to fight Medicare claims fraud.
The new provision would require the Health and Human Services Department (HHS) to hire outside companies to conduct year-long “predictive modeling” analyses designed to identify and prevent illegitimate claims under Medicare Parts A and B.
The analysis would target the 10 states that rank highest for Medicare waste, fraud and abuse — as identified by HHS.
After the year-long analyses, the HHS Inspector General would evaluate the savings to Medicare to gauge the cost-effectiveness of the predictive modeling technology.
If the program shows promising savings, the technologies would be used to evaluate claims in 10 more states for another year. If that process also showed savings, the program would be expanded nationwide. If that also revealed savings, the program would be expanded once more, to include Medicaid and the Children’s Health Insurance Program, or CHIP.
The cost is estimated at $930 million over the next decade, according to Baucus’s office.