As part of the Obama administration’s ongoing effort to combat health care fraud, Health and Human Services (“HHS”) Secretary Kathleen Sebelius and Attorney General Eric Holder announced a new public-private partnership designed to share information and best practices in order to improve detection and prevent payment of fraudulent health care billings. Launched July 25, 2012, the voluntary, collaborative venture brings together the federal government, state officials, several private health insurance organizations, and other health care anti-fraud groups in an effort to expose deceptive schemes that cut across a number of public and private payers. According to a Department of Justice press release, “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.” Further, the new partnership is aimed to “help law enforcement officials to 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.”
Since November 2009, when Executive Order 13520 was issued, the White House has made reducing improper payments and eliminating waste in federal programs a priority, which has resulted in approximately $10.7 billion in recoveries of health care fraud over the past three years. The administration hopes this new partnership will allow for the sharing of information on specific scams, including utilized billing codes and geographical fraud hotspots, so that preventive action can be taken before additional losses related to the scams occur. One specific objective of the partnership is to ensure that payments billed to different insurers for care delivered to the same patient on the same day in two different cities are spotted and stopped.
The partnership’s Executive Board, Data Analysis and Review Committee, and Information Sharing Committee plan to hold their first meeting in September 2012. In the meantime, HHS and DOJ claim that several public-private working groups will finalize the operational structure of the partnership and develop its draft initial work plan.
The following organizations and government agencies are among the first to join the partnership:
- America’s Health Insurance Plans
- Amerigroup Corporation
- Blue Cross and Blue Shield Association
- Blue Cross and Blue Shield of Louisiana
- Centers for Medicare & Medicaid Services
- Coalition Against Insurance Fraud
- Federal Bureau of Investigations
- Health and Human Services Office of Inspector General
- Humana Inc.
- Independence Blue Cross
- National Association of Insurance Commissioners
- National Association of Medicaid Fraud Control Units
- National Health Care Anti-Fraud Association
- National Insurance Crime Bureau
- New York Office of Medicaid Inspector General
- United Health Group
- U.S. Department of Health and Human Services
- U.S. Department of Justice
- WellPoint, Inc.