image: healthdatamanagement

OIG: Medicare Fraud Prevention System needs improvement

Analysts using a system leveraging predictive analytics to identify improper Medicare fee-for-service claims need to improve the process for refining and enhancing its models, according to an audit by the Department of Health and Human Services Office of Inspector General.

The Fraud Prevention System (FPS), first implemented by the Centers for Medicare and Medicaid Services in 2011, uses models that predict suspicious behavior with the goal of preventing the payment of fraudulent claims. However, auditors say CMS might not have the capability to trace the savings from administrative actions back to the specific FPS models that generated the savings.

Read More on Health Data Management