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tci Part B Insider - 2015 Issue 26
Physician Notes: CMS' Analytics System Caught $820 Million in Fraud
Plus: Hospital settles for $218,400 over HIPAA violation.
CMS uses many approaches to catching fraud, and its high-tech analytics system is one of the most lucrative tools for the agency. On July 14, CMS announced that its Fraud Prevention System identified or prevented $820 million in inappropriate payments over a three-year period, with $454 million of that amount in just 2014 alone.
The system uses analytics software to identify questionable billing patterns among Medicare claim submissions. “In one case, one of the system’s predictive models identified a questionable billing pattern at a provider for podiatry services...
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