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Insurers share claims data with HHS to fight fraud

AHIP, UnitedHealth, WellPoint, BCBS, Humana partner with HHS in fraud prevention

Hoping to clamp down on healthcare fraud, private payers like UnitedHealth and WellPoint are partnering with the U.S. Department of Health & Human Services to share more claims information and fraud prevention best practices.

Also joining the initiative announced yesterday are America's Health Insurance Plans (AHIP), the Blue Cross Blue Shield Association and Humana, as well as agencies including the Justice Department and the Federal Bureau of Investigation.

"In the past, we followed a 'pay-and-chase' model, paying claims first--then only later tracking down the ones we discovered to be fraudulent. Now, we're taking away the crooks' head start," HHS Secretary Kathleen Sebelius said.

The partnership particularly aims to share information on "specific schemes, utilized billing codes and geographical fraud hotspots" to catch scam artists before they defraud insurers and prevent, for example, fraudulent billing to multiple insurers for care provided to the same patient on the same day in two different places, LifeHealthPro reported.

Because separate claims can look legitimate, using new technology to analyze data across multiple private and public payers will help law enforcement officials better identify and prevent healthcare fraud, according to Reuters.

"There are mutual interests here in doing a better job at detecting what's probably some $80 billion-plus per year in fraudulent payments across private and public sectors," Richard Migliori, UnitedHealth's executive vice president of health services, told Bloomberg. "There's lot of enthusiasm for doing this right."

The coalition's board, data analysis committee and information-sharing committee start meeting in September. Meanwhile, working groups with government officials and private payer representatives are setting up the coalition's structure and drafting an initial work plan, LifeHealthPro noted.

To learn more:
- check out the LifeHealthPro article
- see the Reuters article
- read the Bloomberg article
- see the HHS announcement

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