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HHS unveils new health care fraud tool

          

Data mining will allow Florida's fraud unit to sort electronic claims through the use of statistical models and intelligent technologies to uncover patterns and relationships.

Orlando Business Journal, July 19, 2010

Health care fraud fighters in the state of Florida will now have additional funding to help find potential fraud and abuse in the state's Medicaid program through the use of Medicaid claims data.

U.S. Health & Human Services Secretary Kathleen Sebelius announced July 15 that she approved Florida's Medicaid waiver request to help fund a demonstration program that will allow the state's Medicaid Fraud Control Unit to "mine" Medicaid Management Information System data to identify cases of potential Medicaid fraud, according to a Health & Human Services release.

Data mining will allow Florida's fraud unit to sort electronic claims through the use of statistical models and intelligent technologies to uncover patterns and relationships. Using the identified patterns, investigators can review Medicaid claims activity and history to find abusive or abnormal use of services and billing that may be potentially fraudulent. Data mining is done with software programs which include algorithms that automatically analyze Medicaid data.

Read more: HHS unveils new health care fraud tool - Orlando Business Journal

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