The Centers for Medicare & Medicaid Services has announced a research contest called the Crushing Fraud Chili Cook-Off Competition to address fraudulent activities within the Medicare program.
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The research challenge invites interested participants to submit potential approaches for detecting anomalies like false billing, upcoding and services not rendered in Medicare Fee-for-Service claims data, CMS said. The agency seeks data-driven methodologies such as explainable artificial intelligence and machine learning technologies for fraud detection. These technologies will analyze large datasets and detect unusual patterns or trends that could signify possible illegal activities.
Aside from detecting patterns, the approach should be able to develop transparent, evidence-based fraud indicators that will be used for flagging fraudulent schemes. In addition, CMS is also looking for scalable technologies for streamlining operations and minimizing manual workload, while keeping humans involved to provide trusted outcomes.
Cook-Off Challenge Details
The competition has two phases. During the first phase, which started on Aug. 19 and will end on Sept. 19, interested teams will submit detailed proposals. Ten finalists will move on to the second phase, from Oct. 31 to Dec.1, where they gain access to a limited dataset of Medicare claims to evaluate their proposed AI/ML approaches.
