Medicare: Predictive analytics working to fight fraud

The Obama administration announced Wednesday that a new anti-fraud program in Medicare doubled the improper payments it identified or prevented this year.

The Fraud Prevention System at the Centers for Medicare and Medicaid Services (CMS) recovered or prevented more than $210 million of improper payments in its second year, the agency told Congress in a report.

The program, which uses predictive analytics to analyze billing patterns, also prompted CMS to take action against 938 providers and Medicare suppliers.

“CMS is using the best of private sector technology to move beyond the ‘pay-and-chase’ approach to protect the Medicare Trust Funds,” said agency Administrator Marilyn Tavenner in a statement.

“We have demonstrated that investing in cutting-edge technology pays off for taxpayers and Medicare beneficiaries.”

Federal health officials are anxious to find new strategies for rooting out waste, fraud and abuse in Medicare as the program becomes more expensive.

While $210 million is a small sum compared to total Medicare spending, the administration said its efforts have led to a record $19.2 billion fraud recoveries over five years.

Critics in Congress are not so satisfied with the results. The CMS announcement came at the top of a House subcommittee hearing on Medicare where Republican blasted the program for “rampant” waste, fraud and abuse.

“Last year, CMS estimated that improper payments were almost $50 billion … This is a shocking amount of taxpayer money to lose every year,” said Rep. Tim Murphy (R-Pa.), chairman of the Energy and Commerce Oversight Subcommittee.