HHS, feds an­nounce new anti-fraud ini­tia­tive

Modern Healthcare - - LATE NEWS -

HHS and the U.S. Jus­tice Depart­ment have part­nered with about a half-dozen health in­sur­ers to help pre­vent fraud and abuse in health­care billing. The ini­tia­tive is de­signed to share in­for­ma­tion on spe­cific schemes, billing codes and even ge­o­graph­i­cal hotspots that have been used in fraud­u­lent ac­tiv­ity. The gov­ern­ment hopes, for ex­am­ple, to be able to im­me­di­ately de­tect when pay­ments are billed for the same pa­tient in two dif­fer­ent cities on the same day. The ini­tia­tive will use ad­vanced tech­nol­ogy and data an­a­lyt­ics to iden­tify when and where health­care fraud is oc­cur­ring, ac­cord­ing to an HHS news re­lease. Trade group Amer­ica’s Health In­sur­ance Plans is par­tic­i­pat­ing in the part­ner­ship with the Blue Cross and Blue Shield As­so­ci­a­tion as well as health plans in­clud­ing Hu­mana, Unit­ed­Health Group and Wel­lPoint. A to­tal of 21 groups, rep­re­sent­ing fed­eral, state and pri­vate pay­ers, have signed on so far. “By shar­ing data, in­for­ma­tion and best prac­tices across all pay­ers, this part­ner­ship will en­sure the pub­lic and pri­vate sec­tors are even bet­ter equipped to fight fraud and will pro­vide a pow­er­ful de­ter­rent to would-be per­pe­tra­tors look­ing to prey on pa­tients and steal money from tax­pay­ers,” AHIP Pres­i­dent and CEO Karen Ig­nagni said in a state­ment. Health­care fraud de­tec­tion has been a sig­nif­i­cant pri­or­ity of the Obama ad­min­is­tra­tion, which has seen a record-break­ing $10.7 bil­lion in re­cov­er­ies dur­ing the past three years, ac­cord­ing to HHS.

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