Home > CMS Updates, Fraud and Abuse > Predictive Modeling Technology from HHS Could Enhance Payor Compliance Programs

Predictive Modeling Technology from HHS Could Enhance Payor Compliance Programs

My partner, Rob Slavkin, recently authored an Akerman Healthcare Practice Update about the Department of Health and Human Services’ “introduction of predictive modeling technology as part of the government’s fraud investigation arsenal, as well as a new collaborative tool that enables private payors to enhance their own monitoring and auditing programs.”  The Practice Update can be found here.

This is part of the government’s ongoing efforts to root out healthcare fraud.

For a reminder at how serious the government is about this, look at what the OIG has been posting on its website.

The adoption and implementation of compliance programs continue to be one of the most  valuable tools to protect healthcare providers, including medical billing companies and DME suppliers, from purposeful or accidental employee activities that may cause exposure to fines, penalties, or possible exclusion from the Medicare and Medicaid programs.  Having and following a compliance can also mitigate criminal penalties.

There is much enforcement activity going on, and it too late to adopt a compliance program when the barbarians are at the gate.

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