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Better Analytical Computer Tools Help Cut Medicare Fraud

September 19, 2011

INDIANAPOLIS - Thanks to the Affordable Care Act, Medicare is now better able to screen providers to make sure they're living up to their responsibilities and not cheating the system.

Over $4 billion was recovered last year in false billings and fraudulent amounts charged to Medicare. John Hammarlund, a regional administrator for Centers for Medicare and Medicaid Services, says the federal health care reform law provides new ways of detecting fraud.

"We now are employing very sophisticated computer-based tools, predictive analytics, pattern modeling, etc., the sort of computer tools that credit card companies use, for example."

Hammarlund says the computer analytics allow them to find fraud in many more instances.

"We can detect some of these things that simply can't be. You can't have one patient receiving the same medical procedure in two different cities at the same time."

According to Hammarlund, the Affordable Care Act has allowed the Centers for Medicare and Medicaid Services to use other new technologies as well to block fraud.

"That law - otherwise known in some circles as health care reform - actually gave our agency additional tools and resources that we didn't have before to try to prevent fraud from happening in the first place."

He says Medicare fraud is rampant.

"Last year alone, our agency recovered over $4 billion - that's with a "B" - dollars in false billings and fraudulent amounts that were charged to Medicare."

Hammarlund says Medicare recipients can also help control fraud by looking over their statements and reporting any discrepancies to 1-800-Medicare.


Leigh DeNoon, Public News Service - IN