; Blue Cross And Blue Shield Association Joins Federal Partnership
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Press Release

Blue Cross And Blue Shield Association Joins Federal Partnership

Private-public partnership collaborates to identify and prevent healthcare fraud

July 26, 2012

WASHINGTON – The Blue Cross and Blue Shield Association (BCBSA) is partnering with the Department of Health and Human Services, federal law enforcement agencies, and private sector stakeholders in a new Health Care Fraud Prevention Partnership that was announced today.

It is estimated that billions in healthcare dollars are lost to fraud each year and countless people are exposed to harmful or unnecessary care.  Prevention, detection and investigation of healthcare fraud and abuse are more critical than ever to safeguard consumers and ensure healthcare dollars are being spent appropriately.

The Partnership is a collaborative effort between public and private organizations to combine resources to more aggressively combat fraud and abuse.  By working together, organizations will be able to better communicate and analyze data, share best practices, and focus on detecting and preventing healthcare fraud.

“The Blues® are pleased to be a part of this collaboration between the public and private sectors that will enhance our fraud prevention efforts and protect patients,” said Scott P. Serota, BCBSA president and CEO.  “The Blues are actively involved with their local law enforcement agencies in rooting out healthcare fraud.  This new partnership will raise to a national level the prevention strategies we know are working in local communities across the country.”

Anti-fraud efforts have long been a robust component of Blue Cross and Blue Shield companies’ commitment to improving the affordability of healthcare services for their members.  In 2011 alone, Blue Cross and Blue Shield companies opened more than 9,000 fraud investigations, and 197 criminal convictions resulted from referrals to law enforcement.  Because of these efforts, Blue Cross and Blue Shield companies collectively saved or recovered $295.8 million for their members.

For example, last year investigators at Blue Cross and Blue Shield of Florida identified significant, suspicious billings for high-cost, injectable drugs at South Florida clinics.  Investigators discovered that Medicare and Medicaid patients were impacted by this scheme, and notified the federal strike force in South Florida.  Through this collaboration, more than 100 individuals were charged with over $450 million in fraudulent billings.  Thwarting this fraud prevented the Florida company from making $6.4 million in more payments to the perpetrators.

“The Blues remain committed to fighting healthcare fraud.  We look forward to working in partnership with consumers, law enforcement, and other authorities to investigate potential fraud cases to keep consumers safe,” Serota said.

About Blue Cross and Blue Shield Association

The Blue Cross and Blue Shield Association is a national federation of 37 independent, community-based and locally-operated Blue Cross and Blue Shield companies that collectively provide healthcare coverage for more than 105 million members – one-in-three Americans.  For more information on the Blue Cross and Blue Shield Association and its member companies, please visit bcbs.com. We encourage you to connect with us on Facebook, check out our videos on YouTube, follow us on Twitter and check out The BCBS Blog, for up-to-date information about BCBSA.