Massachusetts Amnesty Program
Blue Cross Blue Shield of Massachusetts
When Blue Cross Blue Shield of Massachusetts (BCBSMA) audited and sought recoveries from 14 providers in early 2003, the providers complained to their state association and also complained that the association had recommended billing in this manner. The state association sought to intervene on behalf of these providers. The association initially asserted that some or all of the billing code issues could be the result of misinformation, despite an independent consultant's opinion supporting BCBSMA's position. Further audits revealed that hundreds of Massachusetts providers were misusing these codes. Although BCBSMA wanted recovery of as much overpayment as possible, it was also critical to change the billing behavior quickly to avoid future losses.
Program Elements
- BCBSMA implemented a voluntary amnesty program modeled after those used by governmental taxation authorities. Such a program has the advantages of maintaining relationships with providers and professional groups, but still allows for recovery of funds without further legal action.
- Most importantly, an amnesty program allowed BCBSMA to clearly communicate that such misuses will not be tolerated in the future.
Program Results
- The state association published the details of BCBSMA's amnesty program, providing a February 2004 deadline for voluntary participation.
- Provider participation was significant, with 285 providers agreeing to repay several million dollars in overpayments.
- BCBSMA and the state association reinforced proper billing codes while maintaining a relationship.
- Analysis of newer data indicate that the misuse of these codes has virtually ceased.
Contact
Steve Skwara, 617-246-3531, steven.skwara@bcbsma.com
