Thursday
Mar172011
Health and Human Services (“HHS”) Office of Inspector General (“OIG”) issues Proposed Rules on State Medicaid Fraud Control Units (“MFCUs”); Data Mining
HHS, today (March 17, 2011) issued a proposed rule to amend 42 CFR 1007.19(e)(2) to allow State MFCUs to receive Federal funding for use of sophisticated data mining technology in detecting and investigating Medicaid Fraud. Currently, the CFR prohibits MFCUs from receiving Federal matching funds for the costs of data mining .
The Proposed Rule adds a definition of “Data Mining” at section 42 CFR 1007.1. Data Mining under the rule will refer to the “practice of electronically sorting Medicaid claims through statistical models and intelligent technologies to uncover patterns and relationships contained within the Medicaid claims activity and history to identify aberrant utilization and billing practices that are potentially fraudulent.” Currently, MFCUs rely solely on referrals from a Medicaid program integrity unit or other sources for referrals.
At the Federal level, use of data mining and other law enforcement tools, including Medicare Fraud Strike Forces, have resulted in hundreds of criminal charges, convictions and more than $355 Million in court ordered restitutions, fines and penalties for fraud against the Medicare program since 2007. While it is not anticipated that individual State MFCUs would see the same result, HHS anticipates that data mining by MFCUs could enhance the MFCU’s ability to counter new and existing fraud schemes more effectively by identifying early fraud indicators, and to use their resources to take full advantage of their expertise in detecting and investigating Medicaid fraud.
Federal Funding will only be available to MFCUs that satisfy the following conditions that will be promulgated at 42 CFR 1007.20: (1) The MFCU describes the duration of the data mining activity and the amount of staff time to be expended; (2) the MFCU identifies the methods of cooperation between the MFCU and Medicaid agency, and between the MFCU and review contractors selected by the CMS Medicaid Integrity Group; and (3) MFCU employees engaged in data mining receive specialized training in data mining techniques.
Finally, those MFCUs approved for Federal matching funds to engage in data mining will be required to report costs associated with expenditures attributed to data mining activities; the number of cases generated from those activities; the outcome and status of those cases; and monetary recoveries from the data mining activities.
Public comments on the Proposed Rule are being accepted until May 16, 2011 at 5:00 p.m.
Thank you to Lisa Bliss, a member of our Behavioral Health Team, for authoring this entry.
admin
Reader Comments (7)
As I site possessor I believe the content material here is rattling excellent , appreciate it for your hard work. You should keep it up forever! Best of luck.iwc replica watches
I really swiss bell & ross replica
enjoyed this post. You describe this topic very well. I really enjoy reading your blog and watches box
I will definitely bookmark it! Keep hublot swiss replica
up the interesting posts!cartier swiss replica
louis vuitton 2011 handbagsYou can definitely see your enthusiasm in the work you write. The world hopes for more passionate writers like you who are not afraid to say how they believe. Always follow your heart.
Christmas is coming, combine with great happiness and long-awaited reunion…This is a festival for all of us to enjoy our life, to appreciate this year’s harvest and growth, to share all the happiness and bitters with our family, our friends. Let`s write that letter we thought of writing "one of these days", today. In order to share this happiest time in a year, our website takes the role as Santa to send you the most sincere blessing and the most meaningful gift…Come to http://www.dvdbestonline.com to collect what you want, and we’ll send them to your hands with totally free shipping.the fast and the furious on dvd
such as Boy Meets World dvd set, rookie blue on dvd 1000s of tv series free shipping!
more,sign up, $5 you got it!:)
more,Big discount you can get:
5% discount of the postage if you spend USD $30 for postage
3% discount of total amount if you spend USD $100
louis vuitton handbags on saleI appreciate, cause I found just what I was looking for. You have ended my 4 day long hunt! God Bless you man. Have a great day. Bye
Chinese electronic products are popular all across the world as they are very cheap. This is why many people are now buying wholesale products from China electronic wholesalers and are selling them in their own countries.
Most of the online china wholesale dealers maintain a catalogue of Wholesale Watches items on their website which makes it convenient for the wholesale electronics distributor to order for the good that he requires. Some of the popular electronics goods that are popular with buyers include wholesale laptops, Car Satellite GPS Navigation, china wholesale watches, Hello Kitty Watches, Cheap Wholesale Jewelry, MP3 players and many such buy wholesale electronics. For best business relations and good products, choose a wholesaler who offers good warranty on the cheap wholesale products.