Health and Human Services (HHS) Secretary Kathleen Sebelius and Attorney General Eric Holder last week announced a new, voluntary collaboration among the federal and state governments, private health insurance organizations, and other groups “to improve detection and prevent payment of fraudulent health care billings,” according to an HHS press release.
In a nutshell, the program is intended to allow the various participants to share information about potential health fraud schemes and individual “bad actors” within the system. “Another potential goal of the partnership is the ability to spot and stop payments billed to different insurers for care delivered to the same patient on the same day in two different cities,” HHS stated. A third, long-range goal is the use of “sophisticated technology and analytics on industry-wide healthcare data to predict and detect health care fraud schemes.”
The Executive Board, the Data Analysis and Review Committee, and the Information Sharing Committee will hold their first meetings in September.
Government member organizations include:
Centers for Medicare & Medicaid Services
Federal Bureau of Investigations
Health and Human Services Office of Inspector General
New York Office of Medicaid Inspector General
U.S. Department of Health and Human Services
U.S. Department of Justice
Private member organizations include:
America’s Health Insurance Plan
Blue Cross and Blue Shield Association
Blue Cross and Blue Shield of Louisiana
Coalition Against Insurance Fraud
Independence Blue Cross
National Association of Insurance Commissioners
National Association of Medicaid Fraud Control Units
National Health Care Anti-Fraud Association
National Insurance Crime Bureau
Tufts Health Plan
For more information, visit the HealthCare.Gov website.
Tags: Fraud and Abuse