Implement Fraud Prevention Predictive Modeling Prepayment Edits - Analysis and Design Only
Section 4241 of the Small Business Jobs Act of 2010b (Public Law 111-240) mandates the use of predictive modeling and other analytic technologies to identify and prevent fraud, waste, and abuse in the Medicare FFS program. The system implemented through this legislation has significant potential to improve CMS’ ability to prevent payment of fraudulent claims. These
tools have been used successfully in the financial and telecommunication sectors and have applicability to Medicare. The legislation requires the program to be in place by July 1, 2012.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: February 24, 2012
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