Stopping Medicare Fraud CMS Predictive Modeling Initiatives

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cover_PP_July2012_StoppingMedicareFraudCMSPredictiveModelingInitiatives_KZ_NP-1Physicians Practice – July 18, 2012
by Natalie Prazen and Karen Zupko

When CMS releases news that a medical practice or DME provider has been busted for submitting millions of dollars in fraudulent claims, it makes many legitimate physicians and their staff wonder “How did that happen when we can’t even get paid for a new patient visit or test?” The reason is that CMS is stepping up efforts to ferret out fraud through its new Center for Program Integrity (CPI), whose mission is to watch suspect providers/suppliers, their coding, and their claims.

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