In February, the Department of Justice (DOJ) released a statement detailing how the Affordable Care Act (ACA) has empowered the agencies to “take historic steps” toward fighting fraud with new “state-of-the-art technology” to review claims before they are paid, among other things. The statement cites a 2012 goal of the Centers for Medicare & Medicaid Services to cut “the rate of improper payment claims in the traditional Medicare program by half.”

According to a DOJ press release dated Feb. 14, 2012, the ACA empowered the agency to publish new rules that spell out new Medicare and Medicaid participation requirements for providers and suppliers, including licensure checks and site visits to confirm legitimacy and location, and a new Automated Provider Screening system that uses existing information to automatically and continuously verify provider information.

The ACA also gave the agency increased authorization to suspend Medicare payment to providers or suppliers “during the investigation of a credible allegation of fraud;” the use of a new Fraud Prevention System that uses “advanced predictive modeling” technology; and expanded overpayment recovery efforts to Medicaid, Medicare Advantage, and Medicare Part D programs.

In addition, the ACA earmarked $350 million for increased scrutiny of claims before they have been paid, which prompted investments in sophisticated data analytics and an increased number of law enforcement agents and others to fight fraud in the health care system.

Source: U.S. Department of Health and Human Services, February 2012