Medicaid Data Mining ProposedFeds Would Help Fund Anti-Fraud Effort
Current law prohibits use of the federal funds for state Medicaid fraud control units. Comments on the anti-fraud proposal, published in the Federal Register March 17, are due within 60 days.
In making the proposal, HHS notes that data mining at the federal level has helped to identify suspected Medicare fraud.
HHS says that data mining at the state level could help Medicaid fraud control units "counter new and existing fraud schemes by more effectively identifying early fraud indicators. In addition, data mining would equip Medicaid fraud control units with more modern tools that have been shown at the federal level to help increase the numbers of credible investigative leads, pursue recoveries and detect emerging fraud and abuse schemes and trends."
The use of data mining would enable Medicaid fraud control units to operate "without relying solely on individual case referrals from a Medicaid program integrity unit or from other sources," HHS says it its proposed rule.