Consolidating claims databases and discerning suspicious patterns in healthcare billing are technical solutions that federal officials are beginning to use to attack Medicare fraud.
But more needs to be done, according to Health and Human Services Secretary Kathleen Sebelius, who said escalating fraud and abuse has outpaced the resources HHS has had to tackle the problem.
"It's not that we didn't take steps to improve our ability to detect and prosecute fraud," she said at the first national summit on healthcare fraud yesterday "But the problem grew faster than our solutions."
The Health and Human Services and Justice departments convened the gathering so the public and private sector firms could devise strategies to block fraudsters from diverting some of the $1 billion in claims HHS pays out daily.
Among the technical remedies to combat healthcare fraud cited at the meeting are a project by HHS and the Justice Department to develop software to identify criminal activity by analyzing suspicious patterns in claims data,
Medicare is also consolidating claims data, which used to be scattered across multiple databases operated by different contractors. That meant having to search each databases to find out how many claims had been made, for example, for a certain kind of wheelchair.
"Now we're combining all Medicare paid claims data into a single, searchable database," Sebelius said, "which means for the first time ever we'll have a complete picture of what kinds of claims are being filed across the country and where they're being filed from."
Creating benchmarks for normal claims activity beyond Medicare across all payers would help enhance this effort, according to federal and private experts at the conference.
Other remedies cited were the use of predictive modeling techniques to try to interrupt fraud prior to a claims payment instead of having to chase down a bad claim that had been already paid.
Surveillance should also be beefed up of providers who operate "under-the-radar" by generating only moderate amounts of income from fraudulent claims, experts said.
Consolidating claims databases and discerning suspicious patterns in healthcare billing are technical solutions that federal officials are beginning to use to attack Medicare fraud.
But more needs to be done, according to Health and Human Services Secretary Kathleen Sebelius, who said escalating fraud and abuse has outpaced the resources HHS has had to tackle the problem.
"It's not that we didn't take steps to improve our ability to detect and prosecute fraud," she said at the first national summit on healthcare fraud yesterday "But the problem grew faster than our solutions."
The Health and Human Services and Justice departments convened the gathering so the public and private sector firms could devise strategies to block fraudsters from diverting some of the $1 billion in claims HHS pays out daily.
Among the technical remedies to combat healthcare fraud cited at the meeting are a project by HHS and the Justice Department to develop software to identify criminal activity by analyzing suspicious patterns in claims data.
Medicare is also consolidating claims data, which used to be scattered across multiple databases operated by different contractors. That meant having to search each databases to find out how many claims had been made, for example, for a certain kind of wheelchair.
"Now we're combining all Medicare paid claims data into a single, searchable database," Sebelius said, "which means for the first time ever we'll have a complete picture of what kinds of claims are being filed across the country and where they're being filed from."
Creating benchmarks for normal claims activity beyond Medicare across all payers would help enhance this effort, according to federal and private experts at the conference.
Other remedies cited were the use of predictive modeling techniques to try to interrupt fraud prior to a claims payment instead of having to chase down a bad claim that had been already paid.
Surveillance should also be beefed up of providers who operate "under-the-radar" by generating only moderate amounts of income from fraudulent claims, experts said.
Consolidating claims databases and discerning suspicious patterns in healthcare billing are technical solutions that federal officials are beginning to use to attack Medicare fraud.But more needs to be done, according to Health and Human Services Secretary Kathleen Sebelius, who said escalating fraud and abuse has outpaced the resources HHS has had to tackle the problem.
"It's not that we didn't take steps to improve our ability to detect and prosecute fraud," she said at the first national summit on healthcare fraud yesterday "But the problem grew faster than our solutions."
The Health and Human Services and Justice departments convened the gathering so the public and private sector firms could devise strategies to block fraudsters from diverting some of the $1 billion in claims HHS pays out daily.
Among the technical remedies to combat healthcare fraud cited at the meeting are a project by HHS and the Justice Department to develop software to identify criminal activity by analyzing suspicious patterns in claims data.
Medicare is also consolidating claims data, which used to be scattered across multiple d
