New fraud-detection system is behind schedule

11/19/2012 | Modern Healthcare (subscription required)

CMS implementation of a new anti-fraud system will be at least six months behind schedule, according to the Government Accountability Office. The CMS wants to move from a pay-and-chase system to one that spots likely fraudulent claims before they are reimbursed. The new system, modeled after anti-fraud practices in the financial industry, would use predictive analytic models that employ claims data to identify provider and claims that are a high risk for fraud.

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