Claims Analytics Help Medicare Identify, Prevent Provider Fraud

The use of a claims analytics platform helped Medicare to identify and prevent millions of dollars in provider fraud.

“Close to a quarter of new Medicare fraud investigations started with the use of a claims analytics platform that has helped to save approximately $6.7 million in incorrect billings, a new GAO report found. After reviewing fraud prevention procedures and technologies within Medicare in 2016, GAO determined that the Fraud Prevention System (FPS) helped Medicare take corrective actions against 90 providers by suspending improper payments. The review also suggested that the FPS is helping CMS programs curb their historical fraud vulnerabilities.” Read the full article.

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