Data Analytics Fuels Billions of Dollars in Fraud Recoveries Says OIG, CMS

By Kelly A. Briganti, Editorial Director, G2 Intelligence

A common message emerging from the government enforcement agencies is that data analytics have been critical to fraud and abuse efforts. As we mentioned in earlier issues of Lab & Pathology Insider, the OIG reported $2.77 billion in recoveries and CMS claimed using Big Data saved Medicare $1.5 billion in inappropriate payments through its Fraud Prevention System (FPS). The agency explained the FPS uses predictive analytics to stop improper payments before they happen.

An Office of Inspector General’s podcast posted this month also highlights the value of data analytics to the agency’s investigation and enforcement efforts. The agency uses actionable advanced analytics as “high quality lead-generation” for OIG investigators, auditors and evaluators, explained Caryl Brzymialkiewicz, the Chief Data Officer for the HHS Office of Inspector General. The Chief Data Office seeks ways to “democratize data” and make the information gleaned from analytics more useful throughout the OIG—for example, using data to identify compliance hotspots geographically and compare providers to find outliers and identify trends. The information revealed through analytics helps the agency internally as well to inform decision makers when setting priorities and allocating resources and staffing. “[T]hen if we need additional resources, we’re standing on some very solid ground in terms of our logic of what we need when we go back and ask people for additional money,” added Brzymialkiewicz.

The power of data analytics can also help even small to mid-sized laboratories identify proper allocation of resources, improve utilization, cut costs and increase revenue. Informatics has been defined as the science of processing such data. To find out more about how small and medium-sized labs can make use of data by implementing informatics systems, attend G2 Intelligence’s webinar, June 30, 2016 at 2pm EST, A Practical Guide to Informatics System Design and Development for the Small to Mid-Sized Lab: Best Practices for Implementing & Managing a Cost-Effective System on Limited Financial and IT Resources