CMS Steps up Fraud Detection
By Michael D. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, CPMA
Predictive analytics, according to a report in the Government Computer News, is being used to detect fraudulent claims before they are paid. A new system called the Fraud Prevention System (FPS) is one of the “big guns in the government’s battle to reduce improper healthcare claims. FPS is the result of a nearly four-year effort by the Centers for Medicare & Medicaid Services (CMS) to help automate the review of healthcare claims before, during and after they are filed.” FPS uses predictive analytics to catch fraud before CMS pays a claim, which is “critical” to moving away from the previous “pay and chase” model.