June 17, 2011

Whitehouse Praises Implementation of Legislation to Crack Down on Medicare Fraud by CMS

Washington, DC – Today, Health and Human Services (HHS) Secretary Kathleen Sebelius announced that the Centers for Medicare and Medicaid Services (CMS) will begin using a new predictive modeling technology to help crack down on fraudulent Medicare claims before payment is made. This innovative approach to fighting Medicare fraud was funded by legislation cosponsored by Senator Sheldon Whitehouse (D-RI).

Last year, Senator Whitehouse cosponsored and worked on bipartisan Medicare fraud-fighting legislation that was signed into law as part of the Small Business Jobs Act in September. The law requires Medicare to adopt state-of-the- art technology – predictive modeling systems currently used by the credit card and banking industries – to identify potentially fraudulent claims and billing patterns before taxpayer funds are spent.

“Crooks use fraudulent claims to take advantage of our Medicare system. Those dollars should be used to provide care to our seniors, not line the pockets of unscrupulous criminals,” said Whitehouse. “This program both stops fraudulent claims before they are paid out and brings investigation and enforcement of fraudulent claims into the digital age. I commend the Administration for moving quickly to implement this program and to save fraud costs – especially while we work to address the ongoing budget crisis.”

This year, the new technology will be incorporated into Medicare claims processing systems nationwide. The law signifies an important shift from Medicare’s current “pay and chase” model towards one that prevents fraud from happening in the first place.

During the 111th Congress, Senators Whitehouse and LeMieux worked on the Prevent Health Care Fraud Act of 2009, which provided for the development and operation of a predictive model antifraud system in Medicare to identify high risk claims in real-time. Through their efforts, the predictive analytics program was included in the Small Business Jobs Act and signed into law.


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