As part of a Northrop Grumman-led team, Verizon is providing advanced technology to help the federal agency that administers Medicare, Medicaid and the Children's Health Insurance Program improve its detection and prevention of fraud and waste.
On July 1, the agency - the Centers for Medicare & Medicaid Services (CMS) - began using a new fraud management platform that incorporates predictive modeling technology from Verizon to transform the way Medicare fraud is detected. The technology, a customized version of the software platform Verizon uses for its own fraud detection programs, will provide CMS with a highly scalable and fully automated nationwide solution that examines incoming Medicare program claims and routes those that may be fraudulent to case managers for investigation.
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.
"The business of government is changing and federal agencies are increasingly using private sector tools to solve public sector issues," said Susan Zeleniak, group president for Verizon Federal. "For years, Verizon has used predictive modeling in our own business to reduce fraud and improve network security, and the customized version of this platform will help the Centers for Medicare & Medicaid Services reduce fraud and save taxpayer dollars."
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.
Verizon is the largest provider of communications services to the U.S. federal government, delivering a broad range of advanced IT and communications services that help to transform the way government does business. For more information, visit http://www.verizonbusiness.com/federal.
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