HHS Partners with Private Sector to Combat Healthcare Fraud
On Thursday, July 26, the Department of Health and Human Services (HHS) announced a new partnership between the public and private sectors to stomp out healthcare fraud. With HHS funding, federal, state and private organizations have teamed up to help identify and prevent healthcare fraud through information-sharing and cooperation, along with resources afforded by the Patient Protection and Affordable Care Act (ACA) for anti-fraud activities.
In the official press release, Secretary Sebelius stated,
“This partnership puts criminals on notice that we will find them and stop them before they steal healthcare dollars. 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.”
According to the FBI, over $80 billion is lost each year due to healthcare fraud; however, efforts over the past 3 years have resulted in recovery of $10.7 billion. Over 20 federal, state and private organizations have joined forces under this new partnership, including:
- United States Department of Justice;
- Centers for Medicare & Medicaid Services;
- Federal Bureau of Investigation;
- National Association of Medicaid Fraud Control Units;
- New York Office of the Medicaid Inspector General;
- Blue Cross Blue Shield Association;
- AmeriGroup Corporation;
- Humana Inc.; and
- United Health Group.
Initial committee meetings are set to begin in September, with workgroups working to finalize the operational structure and initial work plan of the partnership. Potential goals include sharing information on billing codes, geographic fraud hotspots and specific fraud schemes to prevent losses before they occur, identifying and stopping payments billed on the same day for the same patient, in different cities to different insurers, as well as utilization in the future of technological solutions and analytics to predict and detect fraud schemes.
