The fraud-fighting potential of predictive modeling could take longer to come to Medicare than previously planned. HHS Secretary Kathleen Sebelius told senators at an HHS budget hearing Wednesday that the initiative to add predictive modeling—similar to credit card company tools that detect patterns of card misuse—has encountered delays.
Anti-fraud effort hit snags, Sebelius says
“We've been a little bit frozen in terms of being able to move ahead” with the program, Sebelius told the Senate Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies.
She blamed ongoing congressional budget battle.s for the delays, although she did not answer questions from Sen. Mark Pryor (D-Ark.) about the extent of the delay.
Included in a 2010 small-business law, the predictive-modeling system aimed to move all of the CMS from a “pay-and-chase” model, where claims are automatically paid, to a preventive model, where suspect payments are never made, Sebelius said.
The law required CMS officials to start a competitive bidding process in January for contractors to develop the predictive-modeling software and to implement the technology in 10 states with the highest incidence of Medicare fraud by July. The program was slated to expand to the next 10 highest-risk states in 2012 and nationwide in 2014. The program would spread to Medicaid and CHIP in 2015.
Send us a letter
Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.