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Insurers and the federal government are teaming up to fight health fraud. (iStockphoto.com)

Feds And Health Insurers Partner To Fight Fraud

by Julie Rovner
Jul 26, 2012

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The Obama administration is enlisting new allies to fight health care fraud: insurers.

Today the Departments of Health and Human Services and Justice announced a partnership with more than a dozen health insurers and industry groups to nip fraudulent schemes in the bud, instead of tracking down bad guys after the fact.

"This partnership puts criminals on notice that we will find them and stop them before they steal health care dollars," said HHS Secretary Kathleen Sebelius. "Thanks to this initiative today and the anti-fraud tools that were made available by the health care law, we are working to stamp out these crimes and abuse in our health care system."

Separate claims can look legitimate, she said in a briefing. But when insurers and the government compare notes, things may look different. "By sharing information across payers we can bring this potentially fraudulent activity to light," she said.

Karen Ignagni, president and CEO of the trade group America's Health Insurance Plans added: "Greater collaboration and information sharing between the public and private sectors will enable the nation to more effectively identify fraud early, root it out quickly, and protect patients from the harmful consequences of fraud."

The idea behind the partnership is to share the best ideas of law enforcement, government and industry on things like identifying patterns of suspicious claims, data mining and even something simple like catching simultaneous claims for the same patient in different cities.

It's also part of a broader effort on the government's part to shift from a philosophy known as "pay and chase." Don't wait until after a crime has been committed to take action. Instead, the allies aim to prevent health fraud from happening in the first place.

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