To all VGM members:
CMS has implemented Predictive Modeling of Medicare claims to help identiy, through an analytic system, patterns that present high risk of fraudulent activity. This system was implemented as of June 30, 2011. No claims are being denied at this time. They are gathering information to identify risks scores which will allow CMS to quickly identify unusual billing activity and flag claims for more thorough review prior to releasing payment.
See attached for more detailed account and reference MLN Matters number SE1133 for complete information.
They are finally trying to sift out the rotten apples from the honest suppliers without delaying payment to the honest ones.