New Partnership Combats Healthcare Fraud

There is now a new partnership between health insurers and both federal and state governments. Because of the increased scrutiny of healthcare fraud, this partnership will enable the sharing of data and facilitate the cooperation of investigative best practices to reduce fraud and prevent questionable payments.

Each year, fraud costs Medicare alone approximately $60 billion. U.S. Health and Human Services Secretary (HHS) Kathleen Sebelius expects the partnership will produce results within 12 months. However, there is no budget and claims-data sharing will undoubtedly face significant legal and technical challenges.

Some of the partnership possibilities include:
■ using claims data to catch fraudulent payments
■ sharing information on new fraud schemes
■ utilizing computer analysis to identify emerging fraud patterns

HHS stated a third party will be engaged to sift through Medicare and Medicaid, as well as private health insurance information in order to turn over questionable billing to investigators.


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