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The OIG said today that the anti-fraud predictive modeling that CMS uses as part of its crack down on fraudsters is flawed. The OIG, in its report, goes on to list four steps CMS should take to improve results. Frank Cohen, MPA, senior healthcare analyst for the Frank Cohen Group, a longtime critic of the CMS predictive modeling methodology, nailed the problem when he told RACmonitor that the issue is with the claims database wherein he likens it to “having more noise than signal.” Or, put another way, there’s too much static on the line to clearly hear the other person talking. 
We’ll have a complete report in this Thursday’s news.

Chuck Buck

Chuck Buck is the publisher of RACmonitor and is the program host and executive producer of Monitor Monday.

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