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Highmark Reports More Than $220M in Savings Related to Fraud, Waste, and Abuse

Analysis  |  By Jack O'Brien  
   March 17, 2021

Last year, FIPR prevented approximately $7.5 million in fraud, waste, and abuse related to COVID-19, Highmark stated.

Highmark Health reported Tuesday that the organization generated more than $220 million in savings related to fraud, waste, and abuse.

The Pittsburgh-based company's Financial Investigations and Provider Review [FIPR] department utilized its "sophisticated" AI capabilities and worked with stakeholders such as public health officials and law enforcement to deliver substantial savings. Since 2015, Highmark estimates that FIPR's cumulative impact has exceeded $1 billion.

Last year, FIPR prevented approximately $7.5 million in fraud, waste, and abuse related to COVID-19, Highmark stated, specifically referencing "preventive losses, overpayment recoveries and claim adjustments, and schemes related to vaccines, fake testing sites and personal protective equipment."

Related: Highmark Health Reports $9B in Revenue for First Half of 2020

Additionally, Highmark reported savings of nearly $130 million related to employer-based insurance, $50 million from the Blue Card program, and $22 million from Medicare Advantage. The organization also recorded savings of $9 million from the Affordable Care Act marketplace and $8 million from the Federal Employee Program.

Related: Highmark Defends $10 Million Contribution in Face of Criticism

Highmark detailed how FIPR generates savings by performing "audits to identify unusual claims, coding reviews and investigations that assess the appropriateness of provider payments."

Jeff Bernhard, senior vice president of commercial markets for Highmark Inc., said in a statement that FIPR stop threats facing the organization's 6 million members.

"[FIPR] prevent schemes that not only raise costs, but also potentially put customers’ health at risk," Bernhard said. "For our self-insured customers, who have more exposure to higher-than-expected healthcare claims, these savings go right back to employers and drive down costs for their employees. And for all of our customers, preventing fraud, waste and abuse translates to lower costs and better care.”

Related: Highmark Health Announces $1.5M Commitment to Increase Leadership Diversity

Related: Highmark Health Announces New Chief Diversity and Inclusion Officer

Jack O'Brien is the Content Team Lead and Finance Editor at HealthLeaders, an HCPro brand.

Photo credit: Pittsburgh, PA, USA, 2020-01-11: Downtown Pittsburgh with Highmark building in view / Editorial credit: CiEll / Shutterstock.com


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