Medicaid Data Mining Proposed

Feds Would Help Fund Anti-Fraud Effort
Medicaid Data Mining Proposed
To ramp up efforts to detect Medicaid fraud, the Department of Health and Human Services is proposing a rule that would enable states to use federal matching funds to support Medicaid claims data mining.

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.

About the Author

Howard Anderson

Howard Anderson

Former News Editor, ISMG

Anderson was news editor of Information Security Media Group and founding editor of HealthcareInfoSecurity and DataBreachToday. He has more than 40 years of journalism experience, with a focus on healthcare information technology issues. Before launching HealthcareInfoSecurity, he served as founding editor of Health Data Management magazine, where he worked for 17 years, and he served in leadership roles at several other healthcare magazines and newspapers.

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