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Obama and Insurance Industry Team to Fight Healthcare Fraud

State investigators, private insurers and the Obama administration have teamed up to fight health care fraud. Kathleen Sebelius, the Health and Human Services Secretary, said that the public-private partnership “puts criminals on notice that we will find them and stop them.” Eric Holder, the Attorney General, said that it is “a critical step forward” in the fight against fraud. Fraud has caused many problems in Medicare and Medicaid while also causing problems for private insurance companies.

The organizations involved in the agreement are still hashing out the details. The various methods that could be used when it comes to fighting fraud include computer analytics to discover patterns of fraud, analyzing claims data and sharing information about new fraud scams. It is estimated that over $60 billion per year is defrauded from the Medicare system, leading the Obama administration to strengthen its fight against fraud. The government has already reached multiple settlements with drug companies for violations in marketing practices.

There have been some antifraud schemes launched lately by the government that have yet to create a major stir. For instance, a computer system that cost $77 million was unveiled in the summer of 2011. That computer system is designed to find and end Medicare fraud before it occurs. Since its inception, the system has found only one suspicious payment and it came during Christmas of 2011 that stopped a payment of $7,500 that would have been made.

“Lots of the fraudsters have used our fragmented health care system to their advantage,” Sebelius said. “By sharing information across payers, we can bring this potentially fraudulent activity to light so it can be stopped. 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 healthcare system. This partnership puts criminals on notice that we will find them and stop them before they steal healthcare dollars.”



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Dr. Richard Migliori, the executive vice president of UnitedHealth Group, said, “What’s in it for us is that if you have more data, you are going to be able to recognize aberrant patterns more reliably. These perpetrators are moving around from one place to another. You are going to have more eyes on them and they are going to feel surrounded.”

The President and CEO of AHIP, Karen Ignagni, said, “This partnership is a major step forward in the fight against fraud and abuse. By sharing data, information, and best practices across all payers this partnership will … provide a powerful deterrent to would-be perpetrators looking to prey on patients and steal money from taxpayers.”

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Posted by on July 26, 2012. Filed under Legal News. You can follow any responses to this entry through the RSS 2.0. You can skip to the end and leave a response. Pinging is currently not allowed.
  • Dorothy LaBarbera

    This kind of oversight has been needed for a long, long time. Even everyday, practicing physicians have been known to lean on the MediCare/MedicAid system by ordering too many expensive tests, based on little reason. Some of these tests are invasive and even dangerous. If something goes wrong during a diagnostic test, these doctors make MORE money trying to save their patient! This shady practice works well especially on a patient population that is elderly and/or chronically ill. The unnecessary test or procedure that goes wrong can be blamed on the original condition of the patient. (Also, combination medications used on the aging and chronically ill will mask adverse effects and make it difficult to track down a pattern of serious side effects.) If the medical establishment cannot or will not police itself, then we have to welcome government intervention in an area of our lives that would have been better left to the private sector.

 

 

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