Anti-Fraud Initiatives


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Healthcare fraud is NOT a victimless crime. It increases healthcare costs for everyone.  It is as dangerous as identity theft.  Fraud has left many thousands of people injured.  Participation in healthcare fraud is a crime. 

Did you know?

  • The Centers for Medicare and Medicaid Services estimate that approximately $1.9 trillion was spent on healthcare in the US in 2004. It is estimated that as much as $95 billion of that figure was lost to healthcare fraud.
  • The high cost of fraud extends beyond financial losses. It creates an environment that exploits health care consumers and their private health insurance information.
  • On some occasions, fraud can even jeopardize consumers' health.

Blue Cross and Blue Shield companies aggressively pursue every avenue in tracking down and preventing healthcare fraud. Blue anti-fraud initiatives include sophisticated investigative work, cooperation with federal and state law enforcement agencies and creative use of the Internet and advanced data analysis.

In 2004:

  • Blue Cross and Blue Shield comapnies' anti-fraud efforts resulted in savings and recoveries of nearly $228 million.
  • Blue Plans' Special Investigative Units (SIUs) recovered approximately $120 million and prevented the additional loss of almost $108 million, demonstrating how Blue companies – in partnership with law enforcement aggressively identify and pursue fraud and take swift, corrective actions to minimize damage.
  • Blue Cross and Blue Shield Association's anti-fraud experts help coordinate fraud investigations among the nation's 39 independent Blue companies.  BCBSA's anti-fraud initiatives include:

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Coordinating national anti-fraud investigations through BCBSA's Anti-Fraud Strike Force and the BCBSA Legal Department Cooperative.

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Serving as liaison to the Health and Human Services (HHS) Office of the Inspector General (OIG) and the U.S. Department of Justice including the Federal Bureau of Investigation (FBI)

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Coordinating the Blue System's National Anti-Fraud Advisory Board

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Distributing a consumer guide on fraud, "Don't Be a Victim of Healthcare Fraud," in cooperation with co branding partners: FBI, Coalition Against Insurance Fraud (CAIF) and the Association of Certified Fraud Examiners (ACFE)

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Advising Member Plans on state-of-the-art anti-fraud tools, including software, consulting services and Internet support

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Collecting and analyzing System wide anti-fraud statistics

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Promoting and supporting anti-fraud legislation

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Issuing Special Investigations Unit alerts

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Offering training and educational programs for Blue anti-fraud professionals, and the implementation of a BCBSA-led Strategic Anti-Fraud Enhancement Plan

To learn more about Anti-Fraud, visit http://www.bcbs.com/betterknowledge/anti-fraud/.



 


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