HHS to use data analytics to uncover Medicare, Medicaid fraud

In an effort to plug one of the largest sources of fraud and waste in government, the Health and Human Services Department plans to install data analysis tools to root out fraudulent payments in the Medicare, Medicaid and children's health insurance programs, an official said on Monday.

A proposed rule introduced on Thursday requires the Centers for Medicare and Medicaid Services to screen providers and suppliers to find waste and fraud, including reprimanding the organizations. The rule also extends to those participating in the children's health insurance program.

"The proposed regulations [provide] important new tools to help us move from a 'pay-and-chase' approach," which identifies unscrupulous acts after the government has issued a check, "to one that makes it harder to commit fraud in the first place," said CMS Administrator Donald Berwick during a conference call with reporters Monday.

Medicare is the source of some of the largest amounts of improper payments in government. Agency officials estimated the health program for the elderly issued $24.1 billion in improper payments in 2009, according to a report the Government Accountability Office issued in June. That amount is most likely much higher, GAO added, "because some improper payments may not be detected and hence may not be reflected in the improper payment rate."

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