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Blue Cross and Blue Shield Plans' Anti-Fraud Efforts Recovered and Saved Nearly $228 Million in 2004

Posted on: Monday, 22 August 2005, 15:00 CDT

WASHINGTON, Aug. 22 /U.S. Newswire/ -- Blue Cross and Blue Shield Plans' anti-fraud efforts resulted in savings and recoveries of nearly $228 million in 2004, according to new anti-fraud data released by the Blue Cross and Blue Shield Association (BCBSA). Blue Plans' Special Investigative Units (SIUs) recovered approximately $120 million and prevented the additional loss of almost $108 million, demonstrating how Blue Plans -- in partnership with law enforcement -- aggressively identify and pursue fraud and take swift, corrective actions to minimize damage.

"While our goal is to eradicate healthcare fraud altogether, Blue Plans recognize this is a tall order. That's why it is so critically important that we work cooperatively with all of our fraud detection partners to pinpoint fraud early and stem the financial and physical toll it levies on all of us," explained Byron Hollis, national anti- fraud director, BCBSA. "The new data show that Blue Plans -- working in concert with consumers, law enforcement officials and aided by the broader use of sophisticated software -- are recovering healthcare dollars and making significant strides in the early detection."

Other anti-fraud data released by BCBSA, include:

-- 663 cases were referred to law enforcement authorities, representing an increase of 14.7 percent;

-- 189 warrants and indictments were issued, showing an increase of nearly 17 percent; and,

-- hotline calls received by Plans increased by more than 15 percent for a total of more than 80,000 calls.

According to the National Healthcare Anti-fraud Association (NHCAA), fraudulent health transactions constitute a small fraction of the four billion annual health transactions a year, but carry a high price tag. Estimates by government and law enforcement agencies place the loss to fraud as high as $90 billion, or about five percent of the total $1.8 trillion spent on healthcare in 2004.

Other recent strides against healthcare fraud made by the Blue Plans include a $30 million "Rent-a-Patient" civil lawsuit filed in March 2005. The lawsuit, Blue Cross and Blue Shield of Alabama, et al. v. Unity Outpatient Surgery Center, Inc., et al., filed by 12 Plans in Federal District Court in Los Angeles, alleges that nine southern California-based outpatient surgery clinics, seven medical management companies and 34 individuals were involved in a massive fraud scheme. The scheme victimized hundreds of patients nationwide who underwent unnecessary and sometimes dangerous surgical procedures for which tens of millions of dollars in fraudulent medical claims were submitted. For more information about the lawsuit, go to http://bcbshealthissues.com.

In addition, BCBSA's national Blue Anti-fraud Strike Force -- created in 2004 -- is actively coordinating other Blue efforts to work with federal law enforcement on large healthcare fraud schemes. Comprised of top, seasoned investigators from across the Blue Plans, the Strike Force offers the breadth of experience and knowledge to investigate elaborate fraud schemes that spread across numerous jurisdictions. The Strike Force partners with federal enforcement agencies such as the FBI and the Department of Health and Human Servicesb Office of the Inspector General.

"Blue Cross and Blue Shield Plans continue to lead the way in protecting consumers and employers against the burdensome and wasteful cost of healthcare fraud," stated Hollis. "Consumers have a vital role to play by staying alert. We need consumers to understand the dangers of fraud and promptly report their suspicions. Everyone should review dates and services on their medical bills and protect their health insurance information card like a credit card. Any inconsistencies should be reported to their health insurers or law enforcement officials."

Blue Plan members can report suspected fraud through a national hotline number, 877-327-BLUE, and Web site -- http://www.bcbs.com/ antifraud. In addition, the consumer brochure, "Don't Be a Victim of Healthcare Fraud" is available on that Web site.

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The Blue Cross and Blue Shield Association is made up of 40 independent, locally owned and operated Blue Cross and Blue Shield companies that collectively provide healthcare coverage for more than 93 million -- nearly one-in-three -- Americans. For more information about the Blue Cross and Blue Shield Association and the Blue Cross and Blue Shield companies, please visit http:// www.BCBS.com. For more information on the Blue Cross and Blue Shield Federal Employee Program, visit http://www.fepblue.org.

http://www.usnewswire.com

Source: U.S. Newswire

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