- The Fraud Prevention Systems (FPS) and Medicare Enrollment Premium Billing System (MEPBS) programs were recognized for their outstanding work pushing the envelope, driving innovation, and securing results across vital government agencies.
- Peraton’s FPS program saved the Centers for Medicaid and Medicare over $10 million in costs.
- The company’s ELMO on MEPBS case management tool has become a collaboration platform to over 1,000 case workers and a one-stop solution to over 65 million Medicare beneficiaries.
FORUM Innovation Awards
May 18, 2023
Congratulations to Peraton’s Fraud Prevention System (FPS) and Medicare Enrollment and Premium Billing System (MEPBS) teams for their award-winning efforts.
The 2023 cohort was selected by a panel of Federal and Industry leaders from across the Federal IT sector. The 2023 FORUM Health IT Innovation Award Winners were recognized for their outstanding work pushing the envelope, driving innovation, and securing results across the Department of Veterans Affairs, the Military Health System, the Department of Health and Human Services, and the Centers for Medicare & Medicaid Services.
Awardees will be recognized at the FORUM Innovation Awards and Networking Reception on June 7, in Washington, D.C.
About Peraton’s Fraud Prevention System
Since 2013, the Centers for Medicaid and Medicare (CMS) Fraud Prevention System (FPS) has detected fraud, waste, and abuse (FWA) to minimize taxpayer dollars spent on fraudulent medical claims. The evolution of technology helped enable migration from on-premise data solutions to the cloud, which aided industry alignment with two CMS initiatives: provide access to modernized tools to develop/execute better FWA models and reduce data storage/processing costs. To achieve these initiatives, FPS innovation continuously evaluates analytic toolsets and modernizes platforms as technologies change.
FPS was one of the first programs to implement Snowflake and Databricks as its data warehouse and model development/processing platform. These tools:
- Reduced processing times and cloud costs through streamlined operations
- Accelerated developer access to data
- Enabled development of sophisticated machine learning models that adapt to evolving FWA schemes
- Decreased model time-to-market and increased return on investment via recouped FWA expenditure.
FPS also led updates to change management, ensuring improved model transparency and data governance required to support lawful FWA investigations.
As a result, the cloud migration eliminated over $6M/year in on-premise hardware/licensing costs; migration of models to Databricks saved $2M/year in licensing costs; and migration of processes from Hadoop to Databricks/Snowflake reduced cloud costs by more than $3.2M/year. A yearlong project to modernize models processing code and implement AirFlow decreased processing time from >24 to 8 hours and reduced effort by 60 hours/week. Innovative code wrapper functions automated environment configurations and model testing, saving developers time and harmonizing processes across FPS. Databricks made available hundreds of development packages to create more effective models. Since 2013, automatic FPS claim denials prevented over $686M from going to FWA.
About Peraton’s Medicare Enrollment and Premium Billing System
The Centers of Medicare and Medicaid’s (CMS) Services embarked on an ongoing modernization journey to improve the quality of services provided to Medicare beneficiaries. Following the successful implementation of Eligibility and Enrollment Medicare Online (ELMO) system, an integrated User Interface for Medicare beneficiary back-office work, CMS implemented an integrated Case Management system leveraging the modern ELMO architecture. The ELMO Case Management Tool (CMT) is a one-stop solution for receiving, tracking, resolving and reporting on issues to provide timely and high-quality services to over 65 million Medicare beneficiaries while also improving productivity of CMS case workers and contractors.
The ELMO CMT initiative utilized Human Centered Design (HCD) and Agile approaches on the AWS Cloud, to implement a collaborative Case Management platform. This transitioned Medicare Beneficiary case work previously performed on many disparate CMS applications to an integrated case management system featuring; seamless query/update capabilities on beneficiary demographic, entitlement, eligibility, premium and billing information.
- Case management capabilities include:
- Role-based access
- Team management/collaboration
- Creating/ tracking/ resolving/ reporting on cases
- Integrated document management
- Template-based document/notices generation and bulk printing
ELMO’s automated workflows include ingesting scanned paper mail from beneficiaries and automatic electronic routing to various case management teams for resolution.
As a result, ELMO CMT has become a collaboration platform for over 1,000 case workers across CMS central/regional offices and State Medicaid Agencies to resolve Medicare Beneficiary issues more promptly. It replaced manual email, phone, and paper communication between CMS and states with secure exchange of information and supporting documentation. Case Workers no longer navigate multiple systems such as SWIFT, MAISTRO and NGD to resolve issues and perform all tasks seamlessly within ELMO CMT. The platform is being extended to include Social Security Administration Program Service Centers. The ongoing improvements in collaboration enhance quality of services to beneficiaries and improve Medicare system-wide efficiencies.