Home Health & Hospice Week

Law requires Medicare to use 'predictive modeling' to target claims for pre-pay scrutiny.

A provision buried in the Small Business Lending Act could slow your Medicare cash flow to a trickle next year.

The legislation, which was enacted Sept. 27, mainly addresses credit issues for small businesses. But one provision requires the Centers for Medi-care & Medicaid Services to use "predictive modeling" software to verify suspicious claims before paying them.

The model is based on the ones credit cards use, notes the Miami Herald. Suspicious claims would be flagged for investigation before payment.

"Our health care system is rife with fraud," says Sen. George LeMieux (R-Fla.), who authored the bill. "We need to use up-to-date technologies to stop improper payments. Putting predictive modeling in place will save taxpayers money and make Medicare a better program," LeMieux says.

"Unfortunately, Florida is ground zero for health care fraud and I am hopeful this program will help," the senator adds in a release.

CMS already has the authority to use such software and has been pilot-testing it, a CMS representative tells the Herald. "We have every intention and interest in going forward" with predictive modeling, Peter Budetti, Medicare's deputy administrator for program integrity, tells the newspaper.