Data Analytics Helping To Curb Medicare, Medicaid Fraud, Study Finds

February 21, 2014 in News

Advancements in data analytics technology are helping to curb Medicare and Medicaid fraud, according to a study by University of Cincinnati researchers, Medical News Today reports.

For the study, Michael Czarnecki — a doctoral candidate in UC’s College of Education, Criminal Justice and Human Services — examined how Medicare and Medicaid fraud is controlled. He also looked at control strategies that have been developed over the past 10 years.

Czarnecki presented his study’s findings this week at the Academy of Criminal Justice Sciences annual meeting in Philadelphia.

Findings

The study found that in 2012 Medicare and Medicaid fraud cost the U.S. between about $29.8 billion and $99.4 billion.

However, Czarnecki acknowledged that advancements in data analytics technology have helped federal fraud controllers to better identify and assess “irregular and suspicious patterns of claim submissions.”

He added that improved collaboration and data sharing among federal agencies also has helped to remedy fraud.

In addition, Czarnecki noted that between 2009 and 2011, $7 was returned for every dollar spent to prevent such fraud. In fiscal year 2012, more than $3 billion in Medicare funds were recovered, according to Medical News Today (Medical News Today, 2/20).

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