Identifying fraud in a mountain of Medicare data is an endless pursuit for agents

With nearly 4.5 million Medicare claims coming through the system each day, locating fraud is an endless battle for members of the Medicare Fraud Strike Force, according to the report by The Wall Street Journal.

Members of the Medicare Fraud Strike Force — a multi-agency team of federal, state and local investigators — spend endless hours attempting to locate fraud that accounts for approximately 10 percent of Medicare's yearly spending, which would amount to about $58 billion in fraudulent payments in fiscal year 2013.

Although roughly $58 billion in fraudulent Medicare payments was made last year, the government was able to recover only $2.86 billion of the funds, according to the report.

With such a low recovery rate, CMS launched a predictive-analysis data program to help assist agents in locating fraud. The program scans fee-for-service claims and identifies unusual billing behavior.

In June, the Obama administration announced the new technology used by CMS to combat healthcare fraud prevented more than $210 million in improper Medicare payment in 2013 — the second year of the program.

Due to the success of the still new CMS program, the government is continuing its use of technology in its increased push to recoup Medicare dollars.

More articles on Medicare fraud:

Many Medicare fraud issues addressed in draft bill
10 recent healthcare industry lawsuits
4 recent healthcare fraud cases

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