Healthcare

In 2009, an estimated of waste and fraud cost of Medicare and Medicaid were about $54 billion.
This is including crime schemes created by criminals as health care providers or suppliers, and involving everything from scooter scams to prescription drug sales abuse.

According to Attorney General, Eric Holder, and Kathleen Sebelius from Department of Health and Human Services Secretary, this year a new crop of scam artists has emerged, seeking to profit from misinformation about the Obama Administration’s health care reform.

They promoted the new tools at an event in Boston on Thursday focused on Fraud prevention.

Boston’s fraud prevention summit was the fourth in a series from the agencies, following events in Los Angeles, Miami and Brooklyn, New York.
On the agenda are Detroit, Philadelphia and Las Vegas.

The new approach is based on “predictive modeling,” a combination of advanced analytics, behavioral analysis, linkage analysis, and other statistical techniques.

She compared the modeling tools to ones often used by banks or insurance companies.
For examples, it might throw up a red flag if there are unusual patterns of use on a person’s credit card.

She said, “We want to say ahead of the criminals rather than doing the old pay and chase routine.”
And, “It’s about time we put those kinds of tools to work in the public system,” add Sebelius.

Recently, the Center for Medicare and Medicaid Services (CMS) uncovered two Houston-area companies that had set up “false-front” business by their predictive modeling.

Holder said that health care fraud is evident across the nation, but there are definite hot spots.

He said, “In New England these schemes have reached crisis proportions,” therefore, “we are fighting back in bold, innovative and creative ways.”