tci Medicare Compliance & Reimbursement - 2016 Issue 12

Fraud: Overpayments Are So Last Year -- Now, CMS Will Just Not Pay Your Claims

CMS goes high-tech with fraud-fighting efforts of the 21st century. “Big data” is paying off in a big way for the Centers for Medicare & Medicaid Services (CMS), specifically when it comes to fraud, waste, and abuse. Now, CMS has better techniques than ever before to spot — and halt payments for — any of your claims that CMS’ special data analytics flag as being improper in any way. In a May 27 announcement, CMS touted the huge successes of its Fraud Prevention System (FPS), which uses “big data” and predictive analytics to zero-in on improper Medicare...

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