IT Tools Helped Federal Officials Recover $4.1B in Health Care Fraud


Federal officials say new fraud-fighting techniques -- including IT tools -- have helped the government recover a record high of $4.1 billion in health care fraud judgments in fiscal year 2011, Healthcare IT News reports (Bouchard, Healthcare IT News, 2/15).

The amount recovered last year is about 50% more than the amount recovered in 2009 (AP/Washington Post, 2/13).

Using IT To Fight Fraud

In FY 2011, nine U.S. cities had federal strike force prosecution teams working to identify potential Medicare and Medicaid fraud. The teams used advanced data analysis techniques to:

  • Identify unusually high billing levels in health care fraud hot spots;
  • Track emerging fraud schemes; and
  • Pinpoint criminals posing as health care providers or suppliers (United Press International, 2/14).

Attorney General Eric Holder said the strike force teams "reflect a strong, ongoing commitment to fiscal accountability and to helping the American people at a time when budgets are tight."

Federal health officials also noted that they are doing a better job of sharing data between agencies.

Other Fraud-Fighting Techniques

In addition to using IT-related fraud-fighting techniques, officials from the Department of Justice and HHS officials said they have strengthened Medicare and Medicaid enrollment requirements and are more thoroughly screening health care providers.

Investigators also are conducting site visits to ensure that moderate-risk providers have legitimate offices. Meanwhile, high-risk providers are subject to background checks and fingerprinting (AP/Washington Post, 2/14).
Robert Forster
From experiencing the manipulation of data by this Federal Administration and my state (Ca.) administration, without revealing (where is the transparency?) their definitions and methods, NOTHING can and must not be assumed to be true. This applies to both polical parties. The rules change constantly--now including in savings are projected savings from the discovery out to 10+ years. Where are our controls and watchdogs to monitor the information fed to us? It is certainly not the State government as they have been shown to lack competency in all functional operational areas supported by our taxes. When we switch to new coding system (ICD-10's) new opportunites for fraud will be created since our algorithms are not prepared for the change. One step forwar, two back.

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