CMS Steps up Fraud Detection

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.

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Michael Miscoe

Michael Miscoe

Mr. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, CPMA has over 20 years of experience in healthcare coding and over sixteen years as a compliance expert, forensic coding expert and consultant. He has provided expert analysis and testimony on a wide range of coding and compliance issues in civil and criminal cases and his law practice concentrates exclusively on representation of healthcare providers in post-payment audits as well as with responding to HIPAA OCR issues. He has an extensive national speaking background and has been published in numerous national publications on a variety of coding, compliance and health law topics.
Michael Miscoe

About Has 30 Posts

Mr. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, CPMA has over 20 years of experience in healthcare coding and over sixteen years as a compliance expert, forensic coding expert and consultant. He has provided expert analysis and testimony on a wide range of coding and compliance issues in civil and criminal cases and his law practice concentrates exclusively on representation of healthcare providers in post-payment audits as well as with responding to HIPAA OCR issues. He has an extensive national speaking background and has been published in numerous national publications on a variety of coding, compliance and health law topics.

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