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HHS Inspector General’s Office IDs Health Care Fraud With Analytics

Jeff Brody

The office of inspector general of the Department of Health and Human Services has used data analytics tools to identify fraudulent medical schemes and make decisions on resource allocation, Federal News Network reported Monday.

“If there’s a hotline complaint that comes in, if there’s suspicion of fraud … what we’re trying to do is use the data proactively to both identify potential targets, and also then triage those cases very rapidly,” Caryl Brzymialkiewicz, assistant inspector general, said at a conference in Washington.

The department’s OIG has leveraged analytics to perform “reasonableness tests” on spending data to determine excessive billing practices among health professionals. The office also uses its Payment by Geographic Area platform to identify areas where health care spending is higher than the national average.

“If I’m looking at hospitals, providers, prescription drugs, whatever area I want to look at, I can zoom into a particular area in the country, and then I can get more information about the trends [and] the top providers,” Brzymialkiewicz said of the PAYGAR tool.

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