DHHS awards Medicare fraud contract to TerraMedica

Oct 12 2010

Healthcare Technology firm TerraMedica LLC announced today that it has been awarded a contract by the U.S. Department of Health and Human Services (DHHS)/Office of the Assistant Secretary for Planning and Evaluation. TerraMedica will conduct an assessment of fraud, waste, and abuse in Medicare claims utilizing a pre-payment predictive scoring system.

“This study will go a long ways in providing insight into how much fraud and abuse there is and the potential savings opportunities of utilizing a predictive modeling solution on a prepayment basis, versus a pay and chase strategy”

TerraMedica's system adopts an approach to predictive modeling that is similar to what Financial Services did in the early 1990's, but is unique to healthcare and proprietary in methodology. Today most claim payers and administrators pay claims first and later try to recover or stop fraud and abuse. This contract award will help DHHS and the Centers of Medicare and Medicaid further assess the applicability of predictive modeling technology as a prevention and detection tool against fraud and abuse as well as further refine the estimated amount of fraud and abuse in the system.

TerraMedica's unique combination of Financial Services and Healthcare experience in predictive modeling and fraud and abuse puts them in a unique position to perform this assessment. "This study will go a long ways in providing insight into how much fraud and abuse there is and the potential savings opportunities of utilizing a predictive modeling solution on a prepayment basis, versus a pay and chase strategy," said Allan Klindworth, TerraMedica CEO.