Obama Administration Unites Public and Private Sectors in Fight Against Healthcare Fraud

Several prominent health insurance organizations, fraud groups and other private health care organizations have joined forces with the Obama administration to create one of the largest fraud fighting networks to date, HHS announced, and they are set to get started as early as September. The program is a voluntary, collaborative arrangement designed to share information and best practices in order to improve detection and prevent payment of fraudulent health care billings. The first meetings of the Executive Board, the Data Analysis and Review Committee and also the Information Sharing Committee are scheduled for next month, however, there are many groups that are currently meeting, working to finalize a basic structure for the partnership and developing a work plan.

 For the first time, those on the “front lines” will be working together, “sharing insights” with each other. Public insurance companies face basically the same or similar problems to Medicare and Medicaid, and “by sharing information across payers, we can bring this potentially fraudulent activity to light so it can be stopped. Public and private payers alike — we all have a stake in making sure cheaters don’t undermine our health care system,” according to Kathleen Sebelius.

 This partnership is a critical step forward in strengthening our nation’s fight against health care 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 health care programs, and precious taxpayer dollars.  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.”

 “This partnership puts criminals on notice that we will find them and stop them before they steal health care dollars,” Secretary Sebelius said.  “Thanks to this initiative today and the anti-fraud tools that were made available by the health care law, we are working to stamp out these crimes and abuse in our health care system.”

 The Patient Protection and Affordable Care Act laid the framework for further anti-fraud tools, such as:

• 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.

 These tools have already proven incredibly successful on their own, with over 10.7 billion in health care fraud recoveries in just the last three years. However successful, though, there is significantly more work to be done. Time will tell just how successful this partnership will be.

HHS has released a list of the first to be involved, which include:

  • America’s Health Insurance Plans
  • Amerigroup Corporation
  • Blue Cross and Blue Shield Association
  • Blue Cross and Blue Shield ofLouisiana
  • Centers for Medicare & Medicaid Services
  • Coalition Against Insurance Fraud
  • Federal Bureau of Investigations
  • Health and Human Services Office of Inspector General
  • Humana Inc.
  • IndependenceBlue 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.