State agency upgrading technology to help prevent payment fraud

The Department of Human Services (DHS) said on Wednesday that it  will upgrade data analytics and technologies to modernize crucial program-integrity functions that block improper and fraudulent payments, such as those made through identify fraud. 

"The department makes billions of dollars in payments every year to providers, hospitals, insurance companies and individual recipients," DHS Secretary Ted Dallas said. "Introducing strategies that use data analytics and technology while eliminating cumbersome and error-prone manual processes is a smart way for the department to become more efficient and accurate in the payments we make."

Scheduled changes and actions will include consolidation of the Office of Program Integrity and the Bureau of Program Integrity (BPI), issuing a request for information (RFI) for program integrity data analysis of provider payments, implementing a customer portal for Third Party Liability (TPL), "identity proofing" of program recipients, automating provider enrollment and eliminating manual updating of milestone changes.

"Data analytics is transforming the way that we work across the country," Dallas said. "These innovations can help the department ensure that payments are made only for eligible services while at the same time making it easier for those eligible for benefits to interact with the department."

DHS recovered $582 million in potential improper payments in fiscal year 2014-15. Three-fourths of that amount was made to providers, who represent 98 percent of the total payments annually.

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Pennsylvania Department of Human Services

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