Predictive analytics play new role in fraud detection, but critics want more

The CMS has either identified or prevented more than $210.7 million in healthcare fraud in one year using predictive analytics. But critics want to see the agency do much more with its new digital tools. 91 more words

Hospital Business News

Medicare Expects to Save $400 billion over 10 years by spending $400 Million on Fraud Detection

President Barack Obama’s 2016 budget report was recently released, and the news coming out of Washington, D.C. does not bode well for hospital appellants and the appeals process. 40 more words

Digital Health

WARNING: Individuals promoting genetic testing of Medicare Patients may be committing Medicare fraud and abuse.

by Barbara Parrott McGinity, LMSW

What is Pharmacogenomic Testing?
Pharmacogenomic testing is a new tool in medicine. It is the testing of certain genes to determine how any given individual will respond to specific medications. 411 more words

Healthcare Fraud

Billions wasted by Big Data Healthcare Contractors in a Texas Sized Medicaid Fraud

Over the past 20 years, Texas has privatized computer systems and call centers for its Medicaid program to contractors, including IBM, Accenture (formerly Andersen), Electronic Data Systems, (currently HP), and Xerox.    370 more words


Medicare Fraud 2.0 Prediction

Medicare cuts in fee for service model will end up rewarding physicians for better outcomes. Providers can still work the system by encouraging patients to report positive outcomes.   34 more words