Comment on FR Doc # 2011-06012

Document ID: HHSIG-2011-0002-0008
Document Type: Public Submission
Agency: Inspector General Office, Health And Human Services Department
Received Date: May 16 2011, at 03:15 PM Eastern Daylight Time
Date Posted: June 24 2011, at 12:00 AM Eastern Standard Time
Comment Start Date: March 17 2011, at 12:00 AM Eastern Standard Time
Comment Due Date: May 16 2011, at 11:59 PM Eastern Standard Time
Tracking Number: 80ce1b06
View Document:  View as format xml

This is comment on Proposed Rule

State Medicaid Fraud Control Units; Data Mining

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SAS is supportive of the Agency's proposals to permit data mining activities to uncover fraud before payment. Our concern is that by limiting the ability to search only claims data, investigators may not be able to fully understand the linkages of behaviors and people that should be further investigated. Thus we believe things like call center records and hotline fraud data should also be included. As such, we would recommend a slight modification in the definition of data mining to read as follows: "Data mining is defined as the practice of electronically sorting Medicaid claims and other supporting documentation through statistical models and intelligent technologies to uncover patterns and relationships contained within such information to identify aberrant utliziation and billing practices that are potentially fraudulent."

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