Insurers Join HHS in Fighting Healthcare Fraud

Acknowledging a fragmented system that has enabled "fraudsters to take advantage," the Department of Health and Human Services is again ratcheting up its efforts to uncover healthcare fraud.

HHS announced Thursday that more than 20 groups, including state and local officials, public and private payers, and federal law enforcement agencies, will be part of public-private partnership whose primary goal will be to share experiences in uncovering and thwarting healthcare fraud.

The partnership will share information on fraud trends and best practices to help law enforcement agencies more effectively tackle the fraud challenge. The initial focus is expected to be on specific schemes, billing codes, and geographic hotspots popular with fraudsters. A long-range goal is to use technology and data analytics to predict and detect Medicare and other fraud schemes.

Healthcare fraud costs the country an estimated $80 billion each year, according to the Federal Bureau of Investigation.

HHS Secretary Kathleen Sebelius and Attorney General Eric Holder announced the partnership at the White House with insurance executives in attendance. "This partnership puts criminals on notice that we will find them and stop them before they steal healthcare dollars," Sebelius said  in a press statement.

Health insurers participating in the partnership include Amerigroup, Blue Cross and Blue Shield of Louisiana, Humana, Independence Blue Cross, Tufts Health Plan, UnitedHealth Group, and WellPoint. The Blue Cross and Blue Shield Association and America's Health Insurance Plans are also participating.

The partnership's operational structure and initial work plans are still being developed. In a nod to patient privacy issues that could derail the program, an HHS official noted that many "delicate technical and legal questions need to be worked through in ways that work for a whole complex of public and private organizations."

Work will be divided among three committees: executive, data analysis and review, and information sharing, which will begin meeting in September.

The budget for the program has not been set, although the monies will come from HHS's antifraud funds.

The Patient Protection and Affordable Care Act provides guidance for the partnership in identifying high risk providers and suppliers. According to an HHS official the highest level of risk includes new home health and new durable equipment providers and suppliers.