Rule to Enable Medicaid Data Mining for Fraud

March 17, 2011 – The Department of Health and Human Services on March 17 will publish a proposed rule enabling federal funds to be used for state Medicaid fraud control units to conduct mining of their states' Medicaid claims data.

The rule, from the HHS Office of Inspector General, amends current regulations that prohibit use of federal matching funds for data mining. Fraud units currently rely on referrals from state agencies, providers and private citizens to identify possible cases of fraud.

Permitting federal funding in data mining activities will be an efficient use of available resources, the Office of Inspector General declares in the proposed rule. "At the federal level, analysis of claims data has increased OIG's effectiveness in deploying law enforcement resources and proactively identifying suspected fraud."

The proposed rule, with a 60-day comment period, is available here and in the Federal Register.

This story originally appeared on Health Data Management.

Joseph Goedert is news editor at Health Data Management.

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Data Governance