Data Analytics In Enforcement – The Strategy Is Working

By Anna Grizzle
Gary Cantrell, HHS-OIG Deputy Inspector General, kicked off the HCCA Enforcement Compliance Institute with an update on the OIG’s enforcement efforts that are increasingly driven by data analytics. These analytics help enforcement agencies better identify targets and determine if past enforcement actions accomplish the goal of deterrence.

The efforts appear to be working. After a focus on ambulance billing in the Houston area, Medicare payments decreased by approximately 40% between 2010 and 2014 to Houston ambulance providers after years of increases. Similarly, DME payments in Miami, another Strike Force city, have decreased by $100 million annually since the Strike Force’s launch in 2007.  In total, the OIG has recovered over $22 billion in the past five years.

What can providers take away from these statistics? Know your own data. With the increased use by enforcement agencies of data analytics, providers should be conducting their own analytics to identify any potential aberrations and correct identified problems.  Providers should also understand how they compare to their peers. If a provider is an outlier, the provider should audit claims to ensure the claims have been billed correctly and be prepared to explain why it may be an outlier.  These proactive steps can help providers lessen the likelihood of being the next enforcement target.

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