The initiative will allow federal investigators and insurers to pool claims data from Medicare, Medicaid and private payors to identify suspicious billing patterns. If investigators identify potential fraud, they can alert the private payors of the specific physicians, hospitals and suppliers who are suspect.
Some bills may appear normal on their own, but cross-examining providers’ Medicare, Medicaid and third-party billing patterns can help investigators better detect bilkers.
Cross-examining claims data with payors is a step in another direction for President Obama, who has often criticized the insurance industry in the past three years.
More Articles on Healthcare Fraud:
Feds Charge 48 in Alleged New York Medicaid Fraud Ring
Massachusetts Contracts Company to Detect Medicaid Fraud as it Happens
Largest Healthcare Settlement in U.S. History: GlaxoSmithKline to Pay $3B
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