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CMS Technology Saves $820 Million in First Three Years

On July 14, 2015, the Centers for Medicare and Medicaid Services (CMS) announced that their Fraud Prevention System technology identified and prevented $820 million in improper Medicare payments in first three years of service to protect the Medicare Trust Fund.

After three years of operations, the Centers for Medicare & Medicaid Services (CMS) today reported that the agency’s advanced analytics system, called the Fraud Prevention System, identified or prevented $820 million in inappropriate payments in the program’s first three years. The Fraud Prevention System uses predictive analytics to identify troublesome billing patterns and outlier claims for action, similar to systems used by credit card companies.  The Fraud Prevention System identified or prevented $454 million in Calendar Year 2014 alone, a 10 to 1 return on investment.

"We are proving that in a modern health care system you can both fight fraud and avoid creating hassles for the vast majority of physicians who simply want to get paid for services rendered. The key is data," said CMS Acting Administrator Andy Slavitt. "Very few investments have a 10:1 return on taxpayer money."

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