Preventing Healthcare Fraud
According to the Health and Human Services (HHS), HHS Secretary Kathleen Sebelius and Attorney General Eric Holder announced the launch of a ground-breaking partnership among the federal government, State officials, several leading private health insurance organizations and other healthcare anti-fraud groups to prevent healthcare fraud. This voluntary, collaborative arrangement uniting public and private organizations is the next step in the Obama administration's efforts to combat healthcare fraud and safeguard healthcare dollars to better protect taxpayers and consumers.
The new partnership is designed to share information and best practices to improve detection and prevent payment of fraudulent healthcare billings. Its goal is to reveal and halt scams that cut across a number of public and private payers. The partnership will enable those on the front lines of industry anti-fraud efforts to share their insights more easily with investigators, prosecutors, policymakers and other stakeholders. It will help law enforcement officials more effectively identify and prevent suspicious activities, better protect patients' confidential information and use the full range of tools and authorities provided by the Affordable Care Act and other essential statutes to combat and prosecute illegal actions.
"This partnership puts criminals on notice that we will find them and stop them before they steal health care dollars," Secretary Sebelius said in a release. "Thanks to this initiative and the anti-fraud tools that were made available by the healthcare law, we are working to stamp out these crimes and abuse in our healthcare system."
One innovative objective of the partnership is to share information on specific schemes, utilized billing codes and geographical fraud hotspots so that action can be taken to prevent losses to both government and private health plans before they occur. Another potential goal of the partnership is the ability to spot and stop payments billed to different insurers for care delivered to the same patient on the same day in two different cities. A potential long-range goal of the partnership is to use sophisticated technology and analytics on industry-wide healthcare data to predict and detect healthcare fraud schemes.
The partnership builds on existing tools provided by the Affordable Care Act, resulting in:
- Tougher sentences for people convicted of healthcare fraud. Criminals will receive 20 to 50 percent longer sentences for crimes that involve more than $1 million in losses;
- Enhanced screenings of Medicare and Medicaid providers and suppliers to keep fraudsters out of the program.
- Suspended payments to providers and suppliers engaged in suspected fraudulent activity.
To read the press release in its entirety and see a list of the organizations and government agencies that are among the first to join this partnership, click here.
For more information on the partnership and the Obama administration's work to combat healthcare fraud, go to: http://www.healthcare.gov/news/factsheets/2011/03/fraud03152011a.html and http://www.stopmedicarefraud.gov/