Fraud and Abuse Awareness Training
Anthem Blue Cross and Blue Shield
Approximately 3-10 percent of the total $1.5 trillion spent on healthcare is lost to healthcare fraud. Clearly, this is a significant problem that impacts all participants in the U.S. healthcare system, from insurers to providers and patients. Educating health plan employees to recognize and respond to healthcare fraud and abuse is unquestionably important, yet devoting the time and resources required for such training can be a significant challenge. In 2004, Anthem Blue Cross and Blue Shield launched a Web-based fraud and abuse training program, supplementing the annual face-to-face training conducted by members of the Special Investigations Unit (SIU).
Program Elements
- The rollout of this Web-based training and assessment program has provided several notable advantages . The high quality of the educational content is maintained on a consistent basis, regardless of where or when it is delivered. Anthem Blue Cross and Blue Shield employees have 24/7 access to the course and can use the bookmark feature of the program to start and stop the training if needed. Participation, assessment, and the completion of the online training can be verified automatically. Notices can be generated to remind employees or their managers if the training was not completed.
- Content was designed to be relevant to a wide variety of employees . The material is strengthened by real-world examples of fraud and abuse, and each section is followed by a "What to Look for" section that focuses on the hallmarks of different types of fraud and abuse. Information about how to report potential fraud or abuse is provided, giving employees with guidelines for practical action. Employees complete tests to ensure an 80 percent proficiency level on key concepts.
Program Results
- Participants have shared their enthusiasm about the program in anonymous post-course surveys.
- The majority of respondents favor the use of computer-based training over face-to-face sessions, and a full 92 percent agreed or strongly agreed that a computer format was easy to use.
- Participants lauded the content of the training – 87 percent of the participants agreed or strongly agreed that the training was useful in their work at Anthem Blue Cross and Blue Shield.
Contact
Cynthia Lucas, 513-336-2770, Cynthia.lucas@anthem.com
