- Medicare's predictive analytics technology helped save more than $1 billion during 2014 and 2015, according to a CMS Blog post last week.
- The agency's Fraud Prevention System (FPS) has moved Medicare away from a reactive “pay and chase” strategy toward a preventive strategy that works by identifying fraudulent billing and preventing such payments.
- The FPS has been in place for five years and has continued to hone its detection capabilities over that time, according to the blog, and it now performs analytics on 4.5 million Medicare claims daily.
The FPS is not only credited with saving $1.5 billion, but for reaching a landmark in 2015, said blog authors Dr. Shantanu Agrawal, Raymond Wedgeworth and Kelly D. Bowman. It was the first year the CMS was able to mark a national return on investment of $11.60 for every dollar spent on the system.
The blog went on to tout CMS' development of processes to measure costs avoided through the removal of fraudulent providers from the Medicare program, as well as tracking return on investment. The authors wrote the methodologies developed to calculate cost avoidance were certified by HHS’ Office of Inspector General, which it reports to be the first certification of this kind in federal healthcare programs.
It suggested CMS is not satisfied to stop there, however, adding the agency is at work developing next-generation predictive analytics that will feature an improved design to increase usability and efficiency.
"Using it and other advanced tools," the authors wrote, "we are committed to addressing fraud, waste and abuse in the Medicare program to better protect beneficiaries and taxpayers."