The federal government on July 26 said it’s formally joining forces with the private sector to prevent health care fraud. HHS Secretary Kathleen Sebelius and Attorney General Eric Holder announced a partnership with “leading” private insurers as well as anti-fraud groups and state officials. They say they will share information on billing codes, schemes and geographic hot spots 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,” according to a press release. “Another potential goal of the partnership is the ability to spot and stop payments billed to different insurers for care delivered to the same patient on the same day in two different cities.” HHS and DOJ say they hope in the long run to use advanced data analytics to predict and detect health fraud. The first meeting of three new working groups — the Executive Board, the Data Analysis and Review Committee, and the Information Sharing Committee — will be held in September.
The government’s new private-sector partners include America’s Health Insurance Plans; the Blue Cross and Blue Shield Association; Humana Inc.; the National Association of Insurance Commissioners; the National Health Care Anti-Fraud Association; the National Insurance Crime Bureau; Travelers; and Tufts Health Plan.
What effect could this partnership have on enforcement activities?
Would this change your organization’s approach to compliance?