MeriTalk: CMS Fraud Detection Efforts Building on Further ML Use

“Machine learning (ML), AI, and other advanced technology tools used for detecting fraud at the Department of Health and Human Services’ (HHS) Center for Medicare & Medicaid Services (CMS) are likely to play an increasingly important role in the future of the agency, a CMS official said April 6 at General Dynamics Information Technology’s Emerge 2021 conference on digital modernization.”

“Raymond Wedgeworth, Director of the Data Analytics and Systems Group for the Center for Program Integrity within CMS, said early evidence suggests that the agency’s ML models produce less false positives and are valuable to their partners doing investigations into fraud…”

“Wedgeworth said that for close to 10 years now, CMS and has been using advanced analytics to curb fraud and waste. More recently, they agency has moved into more predictive models and is seeking to start working on fraud that is not yet well known.”

“’What we’re hoping, though, is to expand [learning models] even greater in terms of looking at identifying fraud that’s not known, so as you’re talking about with data bias, right now when we have a lot of the actions that we’ve taken in the past … what you did in the past is then being used to reinforce the new machine learning models,’ Wedgeworth explained.  ‘So, you can end up in an infinite loop and just keep going back to the same thing, so we’re not identifying potentially new and emerging fraud…’” Read the full article here.

Source: CMS Fraud Detection Efforts Building on Further ML Use — By Jordan Smith, April 7, 2021. MeriTalk.

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