Touting a breakthrough in combating rampant fraud in the Medicare and Medicaid health care systems, the Obama Administration on Wednesday told Congress that it had prevented $42 billion of improper payments to doctors and other medical providers in fiscal 2013 and 2014 by using more sophisticated detection methods.
After years of haphazard auditing and enforcement practices that frequently missed multi-million dollar scams, federal authorities under prodding from Congress are now ferreting out corruption through the use of “big data” and predictive analytics, more frequent on-site inspections to check out suspicious activities and better coordination among federal and state authorities.
The results have marked a turnaround in the government success rate in preventing the loss of billions of dollars allotted to the healthcare of seniors, the poor, children and the disabled. The Centers for Medicare and Medicaid Services (CMS) says every dollar that was invested in the agency’s Medicare “integrity efforts” saved $12.40 for the Medicare program.
Source: $42 Billion of Medicare and Medicaid Fraud Thwarted by ‘Big Data’ Analytics The Fiscal Times