TITLE

Part B MACs Now Using 'Predictive Modeling' of Claims to Catch Fraud

PUB. DATE
August 2011
SOURCE
Medicare Compliance & Reimbursement;8/21/2011, Vol. 37 Issue 22, pp171
SOURCE TYPE
Trade Publication
DOC. TYPE
Article
ABSTRACT
The article reports on the announcement by the U.S. Centers for Medicare & Medicaid Services (CMS) that Part B Medicare Administrative Contractors (MACs) is using predictive analyses to scan claims and to detect fraud. CMS has made an effort in streaming all Medicare FFS claims by its predictive modeling technology wherein the system creates profiles of providers, billing patterns, and beneficiary utilization. It notes that the system alerts MACs for a potential fraudulent claim.
ACCESSION #
69719147

 

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