A regional healthcare fraud prevention summit in Philadelphia on Friday brought together a wide array of federal, state and local partners, beneficiaries, providers and other interested parties - including U.S. Attorney General Eric Holder and the Department of Health and Human Services (HHS) Secretary Kathleen Sebelius - to discuss ways to eliminate fraud within the U.S. healthcare system.
"In communities across the country, and particularly here in Philadelphia, health care fraud schemes are being aggressively and permanently shut down. That's, in large part, because of the great work being led by Health Care Fraud Prevention and Enforcement Action Team," said Holder in a statement about the summit.
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"Today, we continue to work with patients to protect their information, with providers to strengthen screening standards, and with private insurers to share strategies about how to prevent fraud," Sebelius added.
At the summit, Sebelius announced that starting July 1, HHS will begin using predictive modeling technology to identify fraudulent Medicare claims on a nationwide basis, and stop claims before they are paid. This initiative builds on the new anti-fraud tools and resources provided by the Affordable Care Act that are helping move the Centers for Medicare and Medicaid Services (CMS) beyond its former "pay & chase" recovery operations to an approach that focuses on preventing fraud and abuse before payment is made.
With the new method, original Medicare claims will be analyzed using risk-scoring technology that applies predictive models, an approach similar to that used by the private sector to successfully identify fraud. For the first time, CMS will have the ability to use real-time data to spot suspect claims and providers and take action to stop fraudulent payments before they are paid.
"This new technology will help us better identify and prevent fraud and abuse before it happens and help to ensure the solvency of the Medicare Trust Fund," CMS Administrator Donald Berwick, MD, said in a statement.