Medicare Fraud Attorney: CMS Armed With New Technology
The Centers for Medicare & Medicaid Services (CMS) announced that the federal government will begin employing innovative predictive technology to detect and combat Medicare fraud beginning July 1, 2011. This initiative was made possible in part by the Affordable Care Act, which provides additional funding to ramp up anti-fraud efforts and to invest in sophisticated data analytics.
The aim of the new technology, known as “predictive modeling,” is to uncover fraudulent claims before the government pays them. Predictive modeling techniques are routinely utilized by banks, credit card companies and other businesses in the private sector to detect potential fraud. This approach uses risk-scoring tools to analyze claims in real time, as they come in. According to a CMS press release, “this initiative builds on the anti-fraud tools and resources provided by the Affordable Care Act that are helping move CMS beyond its former ‘pay & chase’ recovery operations to an approach that focuses on preventing fraud and abuse before payment is made.”
The Centers for Medicare and Medicaid Services will apply the predictive modeling approach to all new Medicare fee-for-service claims beginning July 1, 2011. CMS will run the program through Northrop Grumman, a contracted global security services provider.
Proactive Defense for Health Care Providers – the Compliance Program
One very useful tool to help avoid a prepayment denial through the new predictive modeling technique is the implementation of a comprehensive health care compliance program. Health care compliance programs help to identify areas of risk with respect to coding, documentation, and fraud and abuse laws, and they reduce the likelihood of claim denials and audits. Under the Affordable Care Act, federal law will soon require health care providers to implement a compliance program as a condition of participation under Medicare, Medicaid and CHIP.
Regulatory compliance for health care entities can be very complex, so it is highly recommended to consult an experienced health law attorney for assistance with a compliance program. At The Martin Law Firm, we assist our broad health care client base in the design, development, implementation and review of health care compliance programs and policies. We assist clients with billing, coding and documentation guidelines; fraud and abuse laws, including Stark, Anti-Kickback and the False Claims Act; education and training polices; and investigation and corrective action plans. Preventing legal problems before they begin is always a sound defense strategy. Contact The Martin Law Firm today to discuss your health care compliance and reimbursement needs.
The Martin Law Firm is a health law firm located in Blue Bell, Montgomery County, PA. The Martin Law Firm represents health care providers for matters involving health care compliance, Medicare audits and appeals, insurance post-payment reviews and general business matters. Contact The Martin Law Firm to speak to an experienced health care attorney today.