Strengthening Data Analytics to Combat Healthcare Fraud

Doctor using a digital tablet

Tuesday, June 23, 10:00 a.m. – 12:45 p.m.

Virtual Event

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On June 23, 2020, MITRE will convene government and private industry experts for a virtual discussion of strategies and techniques to strengthen the effectiveness of data analytic techniques used to combat healthcare fraud. As part of our role as an operator of federally funded research and development centers, MITRE sponsors government-wide and government–industry information exchanges.

The June 23 event will focus on government and private industry use of data analytic techniques to combat healthcare fraud. Panelists include Alec Alexander, Director of the Center for Program Integrity for the Centers for Medicare and Medicaid Services, Gary Cantrell, Deputy Inspector of Investigations, Office of the Inspector General, U.S. Department of Health and Human Services; Gregory Heeb, Health Care Fraud Chief, Federal Bureau of Investigations, U.S. Department of Justice (tentative); Matthew Berls, Senior Director, SIU, UnitedHeathcare and Louis Saccoccio, CEO, National Health Care Anti-fraud Association.

As part of this event, MITRE will also also showcase the winner and finalists of the Healthcare Anti-Fraud Academic Competition, developed to discover talented students with innovative solutions that could assist government and private healthcare payers to reduce dollars lost to healthcare fraud. MITRE created the competition to encourage students at U.S.-based colleges and universities to team together to develop innovative analytic approaches for ferreting out healthcare fraud, using a synthetic claims dataset created by MITRE. The competition attracted nationwide interest with 15 teams competing for the final prize.

“The challenge is that success combating healthcare fraud is dependent on advanced healthcare fraud analytic skill, and government and private industry currently lack a robust recruitment pipeline,” stated Rob Case, the initiator of the initial competition concept. “MITRE’s competition goal was to incentivize students to use their analytic skills to uncover healthcare fraud, stimulating interest in the field through competition.”

Winner:

Team SBMiners, University of Texas Health Science Center at Houston,
Congratulations to the SBMiners from the University of Texas Health Science Center at Houston School of Biomedical Informatics. The team submitted a comprehensive investigative plan to identify fraudulent provider clusters and used multiple innovative techniques to identify outliers, including the development of their own analytic tool. They deployed referral network-based anomaly detection to examine provider relationships and to support their findings. Team members include: Yan Chu (Captain), Qian Qian, Wanqi Chen, Tongtong Huang, Gilberto de la Garza. Academic advisors include: Susan H. Fenton, Ph.D.; Xiaoqian Jiang, Ph.D.; Kirk E. Roberts, Ph.D.; and Kang Lin Hsieh, Ph.D.

Finalists:

UAB Blazers, University of Alabama at Birmingham
The team referenced existing research and developed a systematic approach to various fraud hypotheses. This team applied robust analytic processes including geospatial, link, time-based pattern and utilization analysis to reach and support their conclusions. Team members include: Shafiq Islam (Captain), Clint Harrison, Cheryl Malone, Jimmedda Mills, Carole Richardson, Sherly Vadakkoot. Academic advisors include: Bunyamin Ozaydin, Ph.D.; Sue Feldman, Ph.D.; Ferhat Zengul, Ph.D.; Jonathan Patterson, Ph.D.

Rutgers EMBAs, Rutgers University, New Jersey
The team identified multiple important fraud schemes and used multiple advanced technologies to facilitate their analytics. The team focused on one fraudulent provider and strongly supported their findings with multiple visualizations and statistics. Team members include: Derek Kim (Captain), Cara Lerner, Senthil Kumaraswamy, Niranjan Choudhary, Mihir Chokshi, Rajeshkumar Karuppaswamy. Academic advisor is Rosa Oppenheim, Ph.D.

Registration 

Please register. The event will only be granted to those who have pre-registered. Dial-in information will be sent out via email.

Questions? Email: hcfchallenge@mitre.org