OIG expands data analytics

Data analytics provide a vital tool in the OIG’s fraud detection operations. Throughout fiscal year 2021, the agency has focused on expanding this capability, enhancing investigator’s ability to detect potential waste or wrongdoing by identifying providers with unusual billing patterns. Deviation in expected billing patterns does not necessarily indicate wrongdoing; however, it can help identify providers who may warrant a closer review.

During fiscal year 2021, the OIG began developing new detection methods that compile new and existing data sets to show trends in Medicaid utilization. These updates will let OIG staff filter content by increases in services by provider type, regional location and managed care plan. Additional efforts are underway to find opportunities to integrate managed care information into the OIG’s data analytics efforts. By providing information in an easy-to-use format for data intelligence, clinical review and investigative purposes the OIG can more efficiently locate potential healthcare fraud.