1. Provide the title of your story or series and the names of the journalists involved.
Predictive Modeling, Analytics Expanding Fraud-Fighting Toolkit for Regulators By James Swann
2. List date(s) this work was published or aired.
Published in BNA's Health Care Fraud Report on August 11, 2010
3. Provide a brief synopsis of the story or stories, including any significant findings.
This Special Report looks at the potential and current use of fraud-fighting technologies such as predictive modeling and analytical software by the Medicare program to root out Medicare billing fraud and stop payment before claims are filed. Health care fraud in the Medicare and Medicaid programs is a multi-billion dollar a year problem and James Swann spoke with industry experts about why such techniques are important, what is being used today by the Department of Health and Human Services, what can be expected in the future, and outlines congressional interest in the matter.
4. Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?
For the article, James used personal interviews, an SAS white paper, information on the White House blog, and congressional testimony from a June House Ways and Means Health Subcommittee hearing.
5. Explain types of human sources used.
James interviewed a number of software experts at Cary, N.C.-based software company SAS; Douglas Hassebrock, the assistant director for investigations at the Recovery Accountability and Transparency Board (RATB- created by the federal stimulus law in 2009 to track stimulus funding).
6. Results (if any).
n/a
7. Follow-up (if any). Have you run a correction or clarification on the report or has anyone come forward to challenge its accuracy? If so, please explain.
No.
8. Advice to other journalists planning a similar story or project.
James spent a good deal of time talking with the SAS experts. He was going to interview just one source there, but ended up interviewing three individuals with different perspectives. Advice: Try to get software/tech sources to speak "in English." The SAS source was able to explain "behavioral analytics" by comparing it to a scenario where he was stopped from buying a big-screen TV at Best Buy by his credit card company because it was outside of his "normal" behavior.