data mining

Healthcare Data Mining Audits: Impact on Medicare Providers and Suppliers

Medicare, Medicaid & Private Payor Updates /

(June 27, 2012): Healthcare data mining has become quite routine. For instance, in a recent case involving a Missouri psychologist, the provider was indicted and arrested on two counts of healthcare fraud and forgery. At the heart of this case was the fact that the psychologist allegedly submitted claims to Medicare and Medicaid that were […]

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Data Mining is Being Used for ZPICs Targeting Purposes

Medicare, Medicaid & Private Payor Updates /

(November 16, 2011): Many providers believe that their practice is a normal one – average billings, average patient load, costs of care which are consistent with industry standards – and that they need not be concerned with undergoing a Medicare post payment audit for being a “statistical outlier.” As you may know, Medicare and Medicaid

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Predictive Modeling: ZPICs Using Data Mining to Identify Medicare Fraud

Medicare, Medicaid & Private Payor Updates /

(April 15, 2011): Over the last decade, the Centers for Medicare and Medicaid Services (CMS) and its contractors (Zone Program Integrity Contractors (ZPICs), Program Safeguard Contractors (PSCs) and Recovery Audit Contractors (RACs)), have steadily assembled an extensive database of the coding and billing practices of Medicare providers around the country. Analyzing this data, contractors have

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NCI-Owned AdvanceMed Will Remain the ZPIC Responsible for Zones 2 and 5.

Medicare, Medicaid & Private Payor Updates /

(April 10, 2011): Last week, it was announced that NCI, Inc., one of the nation’s most successful information technology companies had acquired the outstanding capital stock of AdvanceMed Corporation (AdvanceMed), an affiliate of CSC. While the acquisition went largely unnoticed by the health care provider community, the transaction may, in fact, be quite significant. With

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