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PPACA: CMS Wants Fraud Detection Tools

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The federal Centers for Medicare and Medicaid Services (CMS) has put out a solicitation for analytical tools that could help it detect fraudulent or wasteful Medicare, Medicaid and Children’s Health Insurance Program payments.

CMS is hoping it can find analytical tools that can help it and other federal agencies participating in the National Fraud Prevention Program prevent abusive payments before they occur.

CMS has been working with the Department of Justice Health Care Fraud Prevention and Enforcement Action Team on efforts to prevent health care fraud.

Banks, credit card companies, commercial insurers and other companies already use predictive modeling tools to identify potential fraud and prevent fraudulent transactions, officials say.

The tools might identify questionable health care providers and questionable billing trends, officials say.

- Allison Bell


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