Medicaid: CMS Offers Cash Prizes for Software that Improves Provider Screening

by Published On: May 30, 2012

The Centers for Medicare and Medicaid Services (CMS) is asking private-sector software vendors to develop a computer application that will help the agency reduce fraud and abuse among Medicaid providers. 

Software engineers who hit the mark will receive prizes totaling between $500,000 and $600,000, according to CMS.

CMS will use the winning software to screen potential Medicaid providers and “keep bad actors from ever getting into the program,” according to Julie Boughn, deputy director at the Center for Medicaid and CHIP Services.

Eligibility criteria for the Provider Screening Innovator Challenge

The Provider Screening Innovator Challenge began May 30 and is expected to run through October or November. Through a series of contests over the next 8 to 9 months, challenge participants will create software products that will be judged by an expert panel of CMS employees. 

Successful software entries must be able to:

  • Verify identities. The winning software will use a “graded screening methodology” that intensifies the level of screening for providers that are flagged as higher risk.
  • Create provider profiles. The software should track provider re-enrollment attempts, gather licensing and financial data, and use public websites to research the conduct of provider associates. “Fraudsters who try repeatedly to enter Medicaid by altering their applications with a slight change will … be blocked,” says Boughn. “The software will also capture licensing information and financial data to spot and stop risky providers.”
  • Evaluate and maintain results. The screening software should analyze the data CMS collects to make sure it is accurate. In addition, the software should explain how it arrived at provider risk scores. 
  • Improve efficiency and cut costs. CMS expects the winning entries to reduce processing and transaction time for system queries as well as the time that providers need to submit information and resolve discrepancies. The software should also yield savings in administrative/infrastructure costs, improve the availability of key provider data and improve the timeliness and accuracy of provider oversight and enrollment, according to the CMS announcement
  • Meet architectural guidelines. Software must meet the standards included in the Guidance for Exchange and Medicaid IT Systems, Version 2.0.

For more information

CMS is conducting the Provider Screening Innovator Challenge in partnership with the National Aeronautics and Space Administration (NASA), Harvard Business School, the State of Minnesota, and TopCoder, an online community of software engineers and computer scientists. 

Software vendors can register for the challenge by visiting NASA’s Center of Excellence for Collaborative Innovation.


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