News at a Glance – June 2016

Medicare Fraud Prevention System Saves $1.5 Billion. The Centers for Medicare & Medicaid Services (CMS) claims Big Data has yielded big savings for Medicare. CMS claims its Fraud Prevention System (FPS) has identified $1.5 billion in inappropriate payments “through new leads or contributions to existing investigations.” In a recent issue of The CMS Blog, the agency explained the FPS uses big data and predictive analytics to proactively ferret out fraud and abuse and prevent improper payments from happening: “Taking ‘big data’ mainstream has given CMS the ability to better connect with public and private predictive analytics experts and data scientists, as well as collaborate more closely with law enforcement. The Fraud Prevention System’s ‘big data’ effort has had a profound impact on fraudulent providers and illegitimate payments by allowing us to quickly identify issues and take action.”

CMS claims that FPS streams 4.5 million pre-paid claims daily and yielded a $11.60 return on investment in 2015 for each dollar spent on the system, recovering $1 billion in savings between 2013-2015. CMS also promises continued focus on use of analytics to fight fraud: “The CMS is now working to develop next-generation predictive analytics with a new system design that even further improves the usability and efficiency of the FPS.”

Theranos Faces More Challenges. The challenges for Theranos continue to mount after the Centers for Medicare & Medicaid Services (CMS) inspected a California facility and rejected initial corrective action measures. The company has invalidated thousands of its tests and now has lost its highly visible business relationship with Walgreens—who terminated its arrangements with Theranos last month. The Chicago-based pharmacy retail giant said that Theranos’ need to invalidate the results of approximately 70,000 tests conducted on its Edison platform and other lab equipment and the rejection of a corrective action plan by the CMS for its lab operations moving forward drove the decision. Theranos itself said it planned to continue to operate sites independently. “We are disappointed that Walgreens has chosen to terminate our relationship and remain fully committed to our mission to provide patients access to affordable health information and look forward to continuing to serve customers in Arizona and California through our independent retail locations,” the company said in a statement.

Biden Launches Genomic Data Commons to Further Personalized Cancer Care. The Genomic Data Commons (GDC) recently launched, as a core component of the National Cancer Moonshot and the President’s Precision Medicine Initiative to promote data sharing between cancer researchers and accelerate the pace of discovery in personalized oncology care. The data platform’s initial release included genetic and clinical information from more than 14,000 cancer patients and tumors. GDC centralizes, standardizes, and harmonizes genomic and clinical data on a unified and interoperable platform. “Today, making discoveries from cancer genomic data is challenging because diverse research groups analyze different cancer datasets using various methods that are not easily comparable,” said GDC principal investigator Robert Grossman, Ph.D., from the University of Chicago, in a statement. “GDC brings together genomic datasets and analyzes the data using a common set of methods so that researchers may more easily make discoveries, and, in this sense, democratizes the analysis of large cancer genomic datasets.”


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