HHS announces new tool to help fight health care fraud
U.S. Health and Human Services Secretary Kathleen Sebelius announced recently that health care fraud fighters in the state of Florida will now have additional funding to help find potential fraud and abuse in the state’s Medicaid program through the use of Medicaid claims data.
Recently, Secretary Sebelius approved Florida’s Medicaid waiver request to help fund a demonstration program that will allow the state’s Medicaid Fraud Control Unit to “mine” Medicaid Management Information System data to identify cases of potential Medicaid fraud.
“To fight health care fraud, we need to coordinate all of the resources and data we can muster,” said Secretary Sebelius. “By allowing the state of Florida to use more information to find potential fraud in Medicaid, this waiver will improve Florida’s ability to effectively identify and combat fraud and abuse.”
a mining is done with software programs which include algorithms that automatically analyze the MMIS data.
Florida MFCU will use federal matching funds to apply sophisticated electronic data mining tools that are beyond the scope of the claims review activities normally performed by the State Medicaid agency to identify potential fraud.