Healthcare scammers got a wake-up call yesterday as Attorney General Eric Holder and Health and Human Services (HHS) Secretary Kathleen Sebelius announced the launch of a groundbreaking public-private partnership aimed at preventing healthcare fraud. This collaborative effort brings together the federal government, state officials, leading private health insurance organizations, and other healthcare anti-fraud groups to tackle the issue of healthcare scams.
The new partnership is designed to share information and best practices to improve detection and prevent payment of fraudulent healthcare billings. Its goal is to reveal and halt scams that cut across a number of public and private payers. The partnership will enable those on the front lines of industry anti-fraud efforts to share their insights more easily with investigators, prosecutors, policymakers, and other stakeholders.
“This partnership is a critical step forward in strengthening our nation’s fight against healthcare fraud,” said Attorney General Holder. “This administration has established a record of success in combating devastating fraud crimes, but there is more we can and must do to protect patients, consumers, essential healthcare programs, and precious taxpayer dollars. Bringing additional healthcare 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 healthcare system.”
The partnership aims to share information on specific schemes, utilized billing codes, and geographical fraud hotspots to take action and prevent losses to both government and private health plans before they occur. One potential goal is the ability to spot and stop payments billed to different insurers for care delivered to the same patient on the same day in two different cities. A long-range goal is to use sophisticated technology and analytics on industry-wide healthcare data to predict and detect healthcare fraud schemes.
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. Health and Human Services
The partnership’s Executive Board, Data Analysis and Review Committee, and Information Sharing Committee will hold their first meeting in September. Until then, several public-private working groups will continue to meet to finalize the operational structure of the partnership and develop its draft initial work plan.
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Key Facts
- State: Federal
- Category: Fraud & Financial Crimes|Public Corruption
- Source: DOJ Press Release ↗
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