When you think about the billions of dollars health insurers lose each year, preventing such losses from fraud could have a huge impact on health costs—especially at a time when insurers are streamlining programs to reduce spending.
BCBSA's news is buffered by a George Washington University School of Public Health and Health Services report last week that found as much as 10% of healthcare spending is lost to fraud. That means the healthcare system loses more than $200 billion annually to fraud.
Employers are also involved in their own fraud prevention programs, which experts say could reduce employee healthcare costs by 2%-5% annually. The ineligible dependent problem is one major type of fraud that comes about because most human resources and benefits departments do not perform checks or require tax returns, birth certificates, and marriage certificates at the time of enrollment. This leaves them open to fraud.
As health insurers, employers, and healthcare organizations struggle during a difficult economy, anti-fraud efforts have gained popularity as a way to cut costs without reducing health programs. For insurers, which are faced with dropping enrollment because employers are cutting health coverage, anti-fraud could play a key role in reducing costs without passing more costs onto employers and ultimately individuals.