CMS implemented a Fraud Prevention System (FPS) using “big data” and predictive analytics approaches to fight fraud, waste and abuse in the Medicare fee-for-service program, five years ago. Since inception, FPS has saved Medicare over $1.5 billion in inappropriate payments through new leads or contributions to existing investigations.
As of 2015, CMS claimed a return-on-investment of $11.60 for every dollar spent on FPS.
“Taking “big data” mainstream has given the CMS the ability to better connect with public and private predictive analytics experts and data scientists, as well as collaborate more closely with law enforcement. The Fraud Prevention System’s “big data” effort has had a profound impact on fraudulent providers and illegitimate payments by allowing us to quickly identify issues and take action. For example, the FPS identified a home health agency in Florida that billed for services that were never rendered. Due to the FPS, CMS placed the home health agency on prepayment review and payment suspension, referred the agency to law enforcement, and ultimately revoked the agency’s Medicare enrollment.”