A proposed framework focusing on development and application of electronic healthcare predictive analytic applications has been published this month in eGEMs (Generating Evidence & Methods to improve patient outcomes).
Predictive analytics are supposed to be the key to preventing healthcare fraud, but as the latest investigation into compounded pharmaceuticals shows, the industry is still a long way from effectively preventing improper payments. Although the signs of abuse were there, government officials employed a long-standing "Whac-A-Mole" approach to enforcement of compounded drugs, leaving investigators to try to claw back millions of long-gone payments.
The Centers for Medicare & Medicaid Services underpaid Medicare Advantage health plans for the costs of treating individuals with multiple chronic conditions, according to a new analysis from Avalere Health.
Big data and predictive analytics were supposed help Medicare prevent fraudulent payments the same way credit card companies deny suspicious charges. Fraud schemes still plague Medicare because the Centers for Medicare & Medicaid Services is too concerned about provider backlash to use the full force of claims data, according to an article published in Pacific Standard.
Penn Medicine's analytics efforts are highlighting how big data can save lives.
State-of-the-art data analytics technology can edit claims to prevent fraudulent Medicare payments, but the human element found in initiatives like the Senior Medicare Patrol still play a crucial role in fraud detection, according to an article by FedTech.
The U.S. Army is taking a more data-driven approach to predicting suicide risk, working on determining when and how to best intervene with patients.
Due to the increase in life expectancy and baby-boomers reaching the age of 65, Medicare spending will likely skyrocket so much that the federal government will have to either reduce spending or increase taxes, according to a new Congressional Budget Office report.
Strength in numbers. It's a tried and true adage that's so universal that it's ben used by high-ranking generals as a wartime strategy, or a pack of disgruntled kindergarteners standing up to the schoolyard bully. For those charged with fighting fraud, it's a maxim that holds true in more ways than one. Data analytics provides the building blocks for fraud detection, but increasingly, states are forming their own healthcare fraud task force to employ a more simplistic approach to fraud enforcement.
A new task force announced by the West Virginia U.S. Attorney's Office will rely on data analytics to uncover healthcare fraud schemes.