“… When it comes to tracking down billions in fraud, waste and abuse each year, federal watchdog agencies have often faced an uphill battle trying to pin down the fraudsters. But through more sophisticated big-data tools, many of those same watchdogs now have an upper hand in bringing bogus health care claims to court.”
“Tim Persons, the Government Accountability Office’s chief scientist, said these data analytics tools, powered by artificial intelligence algorithms, have helped agencies ‘deal with messier, larger data sets.’”
“These tools, he added, won’t replace auditors or investigators, but will serve as a force multiplier for the staff agencies already have…”
“Through these data analytics tools, HHS OIG has been able to run ‘reasonableness tests’ on spending data to see if medical professionals have billed for services that would exceed their capacity…”
“The agency can also provide big-picture analytics through its Payment by Geographic Area (PAYGAR) tool, which overlays health care spending data on a map and flag areas where the average level of medical spending is double or triple the national average…”
“But the algorithm never tells the full story, and analysts can often find anecdotal information to explain outliers in the data…” Read the full article here.
Source: HHS IG office ‘putting data at the fingertips’ of its investigators in the field – By Jory Heckman, September 30, 2019. Federal News Network.
