On Thursday, HHS' Office of Inspector General published in the Federal Register a proposed rule that would allow states to use federal funds to mine state Medicaid claims data to identify and curb fraud, Modern Healthcare reports.
The proposed rule would amend a current HHS provision that prohibits state Medicaid fraud control units from using federal funding to electronically sort claims data to identify fraudulent practices (McKinney, Modern Healthcare, 3/17). Currently, state fraud units rely on referrals from state agencies, health care providers and private citizens to identify possible fraud.
In the proposed rule, OIG notes that data mining has been an effective tool to identify fraud at the federal level and that allowing states to use federal funding for data mining activities would be an efficient use of resources (Goedert, Health Data Management, 3/16).
Under the rule, states would be required to provide OIG with annual data on:
- The cost of data mining;
- The number of fraud cases generated; and
- The outcome of the cases (Modern Healthcare, 3/17).
The proposed rule has a 60-day comment period (Health Data Management, 3/16).