Medicare Hires Northrup Grumman For Predictive Modeling Anti-Fraud Project
The defense contractor will develop rapid methods to analyze Medicare claims before they are paid. Meanwhile, CNN reports on how "phantom pharmacies" are a new trend in health care fraud.
Modern Healthcare: CMS Taps Northrup Grumman For Anti-Fraud Project
Anyone familiar with the predictive-modeling techniques that allow credit card companies to detect suspicious charges at the cash register might wonder why the CMS couldn't do the same thing with all the blatantly fraudulent charges sent to Medicare. Officials say the federal Medicare payer has just inked a $77 million contract to do exactly that, hiring defense contractor Northrup Grumman under a multi-year deal to develop rapid predictive-modeling methods that can analyze claims for federal payments before the bills are paid (Carlson, 6/17).
CNN Money (Video): Phantom Pharmacy - A Growing Health Care Fraud
Like a nasty bug, a relatively new fraud is spreading through the health-care system. Criminal enterprises pose as pharmacies, and -- by billing Medicare, Medicaid and private insurers for supposedly filling prescriptions -- they're bilking the system out of millions of dollars, federal officials say. "These scams are exploding. They're a huge issue for the department," said Shimon Richmond, a field agent with the Department of Health and Human Services (Kavilanz, 6/20).