Robert Pear writes in the New York Times, Medicare receives more than a billion claims a year from doctors, hospitals, pharmacies, suppliers of medical equipment and other providers. Increasingly, the government uses “data mining” techniques to identify providers and claims that pose the greatest risk of fraud.
Kathleen Sebelius, the health and human services secretary, and Attorney General Eric H. Holder Jr. are scheduled to join insurers to unveil the initiative at the White House on Thursday.
“This partnership brings together the resources and best practices of government and private sectors, giving us an unprecedented ability to detect and stamp out health care fraud,” Ms. Sebelius said. (Health Care Managers like ‘best practices.’)
The charter for the venture says that federal investigators and insurers will pool claims data and look for suspicious billing patterns and aberrations. If agents detect possible fraud and begin an investigation, they can provide insurers with the names of doctors, hospitals and suppliers suspected of misconduct.