New attack launched on Medicare, Medicaid fraud | Philadelphia Inquirer | 2011 ...

The fight against Medicare and Medicaid fraud will take a new technological twist on July 1, when the federal government begins using computerized predictive modeling software to flag would-be criminals before they get a check from taxpayers.

The system will enable the government to collect and analyze information so it can spot potential fraud rather than simply evaluate one claim at a time, said Health and Human Services Secretary Kathleen Sebelius and leaders from the Center for Medicare and Medicaid Services (CMS) in an announcement Friday.

The system will use technology similar to that used by banking and telecommunication companies to spot fraud. The $77 million in funding comes as part of the Patient Protection and Affordable Care Act passed in 2010.

"Medical data is in lots of different pots," Sebelius said at a news conference after the announcement at a summit on health-care fraud that is being held at the University of the Sciences in Philadelphia. "We wanted to be able to spot the doctor claiming to be in the six cities billing for the same procedure on the 16th of June."

U.S. Attorney General Eric Holder joined Sebelius and others involved in fighting health-care fraud at the summit. This is the sixth such gathering, following ones held in Miami, Los Angeles, Brooklyn, Boston and Detroit.

The Obama administration has pushed for fighting fraud as part of its much-discussed health-care plan. The two cabinet-level departments joined forces in May 2009 and tried to better deploy people and resources to fight Medicare and Medicaid fraud for its own sake but also because the federal budget is under greater duress.

Holder said that using the investigative units of the FBI, U.S. Attorneys' Offices, Medicare and Medicaid, and the FDA, the government has obtained nearly $8 billion in judgments, settlements, fine, restitutions and forfeitures in the last two years.

Those cases have involved multinational companies and individuals. The U.S. Attorney's Office in Philadelphia has been one of the most active, given the pharmaceutical companies in the area, but individuals have been caught and prosecuted.

"We were inspired by our common cause - and by common sense," Holder told the approximately 320 summit participants.

The computerized tracking system is part of that cause. Sebelius said the real-time hope for the system is akin to when a credit card company "can alert you to 12 flat-screen televisions being billed to your card from a town you've never been to.

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