New Predictive Modeling Software to Aid Feds in Battle Against Fraud

On July 1, the federal government will begin using computerized predictive modeling software to collect and analyze information to spot potential fraud. The software will sort information gathered from Medicare and Medicaid claim forms to generate a risk score for claims. If a risk score reaches a particular level, the system will flag that claim for further investigation by Centers for Medicare and Medicaid Services and the Office of the Inspector General. Prompt payment provisions will be waived for claims that are flagged as suspicious.

$77 million in funding for the system is provided as part of the Patient Protection and Affordable Care Act signed into law last year. Northrop Grumman, National Government Services, and Federal Network Systems, a subsidiary of Verizon, are working on the system.

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