Case Study: Centers for Medicare & Medicaid Services (CMS) combats Medicare & Medicaid fraud and recovers $3.3B with Ephesoft

Combating Medicare and Medicaid Fraud with Ephesoft

The Centers for Medicare & Medicaid Services (CMS) faced a multibillion‑dollar problem with Medicare and Medicaid fraud, abuse and waste, manually reviewing millions of patient records and contending with high improper payment rates (12.1% in FY2015). To modernize claims processing and fraud prevention, CMS implemented Ephesoft Transact — Ephesoft’s machine‑learning document capture platform — to automatically classify and extract data from paper and digital records.

Using Ephesoft’s platform, CMS expedited millions of documents and claims per year, digitized and organized claim data for faster audits, and reallocated roughly 33% of staff from manual processing to higher‑value work. As a result, CMS reported $3.3 billion recovered in FY2016 and an approximately 2% reduction in improper payment rates, translating to billions in savings, and is exploring Ephesoft’s advanced analytics to detect anomalies even faster.

Centers for Medicare & Medicaid Services (CMS)