HHS Proposed Rule To Modify Prohibition on Payment of FFP for Data Mining

To increase effectiveness of State Medicaid Fraud Control Units (MFCU) in eliminating Medicaid fraud, on Thursday, March 17, 2011, the Office of Inspector General issued a proposed rule to permit Federal Financial Participation (FFP) for data mining activities. For purposes of the proposed rule, data mining refers to electronically sorting Medicaid claims through statistical models and intelligent technologies to uncover patterns and relationships contained within the Medicaid claims activity and history to identify aberrant utilization and billing practices that are potentially fraudulent.

Under the proposed rule, the conditions under which an MFCU may claim FFP in costs of data mining include the following: (1) The MFCU describes the duration of the data mining activity and the amount of staff time to be expended; (2) the MFCU identifies the methods of cooperation between the MFCU and Medicaid agency, and between the MFCU and review contractors selected by the CMS Medicaid Integrity Group; and (3) MFCU employees engaged in data mining receive specialized training in data mining techniques.

HHS is soliciting public comments on this proposed rule until 5 p.m. on May 16, 2011.