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Obama administration announces partnership to combat healthcare fraud

July 26, 2012
by Dennis Grantham
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Big health insurers join with CMS, FBI, and administration in voluntary partnership to pool data, exchange information, and more effectively identify, prevent, or prosecute identify healthcare billing fraud.

Health and Human Services (HHS) Secretary Kathleen Sebelius and Attorney General Eric Holder today announced the launch of a voluntary partnership among the federal government, state officials, leading private health insurance organizations, and other health care anti-fraud groups to prevent health care fraud. 

The new partnership is designed to share information and best practices in order to improve detection and prevent payment of fraudulent health care billings that cut across both public and private payers. The partnership will enable those involved to exchange information and insights more easily with investigators, prosecutors, policymakers and other stakeholders. The goal is to help law enforcement officials to more effectively identify and prevent suspicious activities, protect patients’ confidential information and use the full range of tools and authority provided by the Affordable Care Act and other  statutes to combat and prosecute healthcare fraud.

One function of the partnership is to share information on specific schemes, utilized billing codes and geographical fraud hotspots so that preventive action can be taken to prevent losses before they occur. Another is to spot and stop payments to multiple insurers or payers for services to the same patient on the same day. Officials expressed hope that the partnership, which involves data sharing across the healthcare industry, might also result in better analytical and predictive mechanisms that could detect and halt fraudulent schemes sooner.

"Bringing additional health care industry leaders and experts into this work will allow us to act more quickly and effectively in identifying and stopping fraud schemes, seeking justice for victims, and safeguarding our health care system,” said Attorney General Holder.  The partnership's Executive Board, Data Analysis and Review Committee, and Information Sharing Committee will hold their first meetings in September.  Until then, several public-private working groups will continue meeting to finalize the partnership's operating strucure and initial work plans. 

The following organizations and government agencies are among the first to join this partnership:

  • America’s Health Insurance Plans
  • Amerigroup Corporation
  • Blue Cross and Blue Shield Association
  • Blue Cross and Blue Shield of Louisiana
  • Centers for Medicare & Medicaid Services
  • Coalition Against Insurance Fraud
  • Federal Bureau of Investigations
  • Health and Human Services Office of Inspector General
  • Humana Inc.
  • Independence Blue Cross
  • National Association of Insurance Commissioners
  • National Association of Medicaid Fraud Control Units
  • National Health Care Anti-Fraud Association
  • National Insurance Crime Bureau 
  • New York Office of Medicaid Inspector General
  • Travelers
  • Tufts Health Plan
  • UnitedHealth Group
  • U.S. Department of Health and Human Services
  • U.S. Department of Justice
  • WellPoint, Inc.

The partnership builds on existing tools provided by the Affordable Care Act, resulting in:

  • Tougher sentences for people convicted of health care fraud. Criminals will receive 20 to 50 percent longer sentences for crimes that involve more than $1 million in losses;
  • Enhanced screenings of Medicare and Medicaid providers and suppliers to keep fraudsters out of the program.
  • Suspended payments to providers and suppliers engaged in suspected fraudulent activity.

 

For more information on this partnership and the national effort to combat health care fraud, please visit www.healthcare.gov/news/factsheets/2011/03/fraud03152011a.html or visit www.stopmedicarefraud.gov.

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