The office of inspector generalÂ of the Department of Health and Human Services has used data analytics tools to identify fraudulent medical schemes and make decisions on resource allocation, Federal News Network reported Monday.
âIf thereâs a hotline complaint that comes in, if thereâs suspicion of fraud â¦ what weâre trying to do is use the data proactively to both identify potential targets, and also then triage those cases very rapidly,â Caryl Brzymialkiewicz, assistant inspector general, said at a conference in Washington.
The departmentâs OIG has leveraged analytics to perform âreasonableness testsâ on spending data to determine excessive billing practices among health professionals. The office also uses its Payment by Geographic Area platform to identify areas where health care spending is higher than the national average.
âIf Iâm looking at hospitals, providers, prescription drugs, whatever area I want to look at, I can zoom into a particular area in the country, and then I can get more information about the trends [and] the top providers,â Brzymialkiewicz said of the PAYGAR tool.