On Friday, CMS published a notice on the Office of the Federal Register’s website stating that CMS is seeking approval of a new information collection request from the Office of Management and Budget (“OMB”). CMS seeks to expand its Medicare Probable Fraud Measurement Pilot, which would “establish a baseline estimate of probable fraud in payments for home health care services in the fee-for-service Medicare program.”
If this request is granted, CMS will begin collecting information from randomly selected home health agencies, referring physicians, and Medicare beneficiaries. CMS agents will then use this information to estimate the percentage of total payments that are likely fraudulent for Medicare fee-for-service home health.
This notice indicates a recent uptick in the government’s use of datamining to identify potentially fraudulent billing to federal healthcare programs. As we noted in a recent post, government agencies have begun to increase their focus on data analysis as part of their fraud detection practices.
From the perspective of providers, the government’s recently increased focus on information collection emphasizes the importance of knowing and understanding one’s own data. Providers should have a strong handle on their data and should be actively seeking to identify any issues in their data that might raise a red flag to the government. One step providers can take to help protect themselves is to compare their own billing patterns to those of their peers and competitors.
We offer robust data analysis for our clients and are happy to assist clients with the task of harnessing and understanding their own data, which can often be a daunting task for providers. Using our unique and comprehensive data analysis system, we have the ability to create interactive data visualizations to help clients take proactive action and resolve potential billing issues.
The CMS notice is open to public comments, which are due on April 5th.
 Office of the Federal Register