Stakeholders want CMS to use analytics to stop fraudulent payments

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In a July 17 House Ways and Means Committee hearing, government officials heard testimonies on techniques to combat Medicare fraud, according to the Politico Morning eHealth newsletter.

Witnesses told the Oversight subcommittee that CMS should turn to analytics as an anti-fraud tactic. This compares to the agency's traditional "pay-and-chase" model, in which Medicare pays providers first before retroactively hunting down fraudulent or improper payments.

Using analytics, witnesses said CMS could identify fraudulent payments before they happen.

In 2011, CMS moved toward a computerized "Fraud Prevention System" that has saved $6.30 for every dollar spent in fiscal year 2016, a CMS witness said at the hearing, according to Politico.

However, others said CMS should push even harder to root out fraud in healthcare. A witness from the Office of the Inspector General said CMS can't definitively link any specific savings to that model. Another witness from the Government Accountability Office said CMS should review fraud across all its programs.

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