The Algorithm Coded Claim: Who Owns the Liability?

The Algorithm Coded Claim: Who Owns the Liability?

The Centers for Medicare & Medicaid Services (CMS) operates a surveillance platform called the Fraud Prevention System (FPS) that analyzes Medicare claims across the full fee-for-service stream — before payment is made — using predictive analytics specifically designed to detect aberrant billing patterns. It is applied nationwide against every fee-for-service (FFS) claim before payment. It does not wait for a complaint. It runs continuously at a…