NEW YORK July 20, 2011
The fraud detection solution, part of CMS’ National Fraud Prevention Program, is aimed at helping to identify fraud before payments are made, thus reducing both improper payments and the cost and time involved with traditional pay-and-chase recovery operations.
Predictive modeling is commonly used in the financial services and telecommunications sectors to combat fraud. It employs advanced analytics – including link, behavioral and statistical analysis – to monitor huge volumes of information in near real time and help to identify potentially fraudulent requests prior to payment or processing.
Northrop Grumman, as the prime contractor on the CMS Predictive Modeling Development task order, will provide overall program management and contract oversight. National Government Services, a WellPoint subsidiary, will provide Medicare fee-for-service expertise, development of algorithms for fraud prevention, and hosting of information technology and infrastructure.
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