Public-Private Partnership Focuses On Prevention

The Obama administration has launched a new public-private collaborative effort to help prevent healthcare insurance fraud.

The voluntary group includes healthcare organizations and associations, health insurers, federal and state agencies, and anti-fraud groups that together aim to combat healthcare fraud through the sharing of information and best practices. Goals include improving detection of suspicious activity and stopping fraudulent billing before fake claims are paid.

In announcing the initiative July 26, Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder said they hope the project will enable those on the front lines of the fraud-fighting effort to share their insights with investigators, policymakers and law enforcement.

“This partnership puts criminals on notice that we will find them and stop them before they steal healthcare dollars,” Sebelius said in a statement.

An objective of the partnership is to share information on specific schemes, utilized billing codes and geographical fraud hotspots so that action can be taken to prevent losses to government and private health plans.

The coalition hopes to develop 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. Eventually, the group also hopes to use sophisticated analytics on industrywide healthcare data to predict and detect healthcare fraud schemes.

Participants include:

  • America’s Health Insurance Plans;
  • Amerigroup Corp.;
  • 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.