HHS to deploy new anti-fraud software for Medicare

New predictive modeling software is being paid for under Affordable Care Act

The Health and Human Services Department will begin nationwide deployment of new anti-fraud modeling software on July 1, HHS Secretary Kathleen Sebelius announced Jun 17.

“HHS will begin using innovative predictive modeling technology to identify fraudulent Medicare claims on a nationwide basis, and stop claims before they are paid,” the department said in a news release.

Jeffrey Zients, deputy director of the Office of Management and Budget, wrote on the White House Blog in a June 17 entry that the new software is similar to that used by credit card companies to identify potential fraud. This program builds on tools used by the board overseeing spending under the economic stimulus law of 2009, he added.


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The software program is intended to move HHS away from its former approach of paying questionable claims before investigation to a new approach that focuses on prevention before payment is made, officials said.

In fiscal 2010, Medicare recovered more than $4 billion that had been paid due to false claims and other fraud, officials said. That was a 56 percent increase over the $2.6 billion recovered for Medicare in fiscal 2009, HHS added.

Under the Affordable Care Act that funds this program, federal authorities will have access to $350 million over 10 years to fight fraud in the health care system, HHS said.

About the Author

Alice Lipowicz is a staff writer covering government 2.0, homeland security and other IT policies for Federal Computer Week.

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