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Data analytics detect fraud schemes in Florida

In Jacksonville, identifying billing abnormalities leads to multi-million dollar settlements

Enforcement officials in Jacksonville, Florida, are relying on data analytics to uncover fraud, waste and abuse, a method that has already paved the way for several multi-million dollar settlements this year, according to the St. Augustine Record.

After recording just one fraud settlement for $50,000 in Jacksonville in 2013, U.S. Attorney A. Lee Bentley promised to devote more resources toward prosecuting fraud in central Florida. Through the first half of 2015, the city had recorded 15 settlements totaling $34.5 million, ranging from hospitals and ambulance companies to home health providers.

Bentley credits the crackdown in Jacksonville to Assistant U.S. Attorney Jason Mehta, who has used his degree in computer science from the University of California Berkley to identify abnormalities within billing claims.

"If you understand how to use the data, you can identify outliers, you can find the doctor that's billing for 30 hours a day, you can find things that's physically impossible," he told the Record.

The focus on data has led to high-priced settlements, but it's also sparked investigations that act as a deterrent to future fraud schemes. After cracking down on ambulance providers, hospital-to-home transports have dropped by a third, Mehta told the newspaper.

These methods mirror the national push toward data analytics to prevent fraud, waste and abuse. Recently, organizations like the FBI are using data analytics to uncover fraud faster and more efficiently. In certain fraud hotspots, data mining has helped prevent fraud schemes from gaining momentum.

For more:
- read the St. Augustine Record article

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