Federal Announcement of a Public-Private Partnership to Prevent Health Care Fraud

Health Law Bulletin

Federal Announcement of a Public-Private Partnership to Prevent Health Care Fraud

August 7, 2012

In an effort to leverage more effectively private and public payor data and other considerable anti-fraud enforcement tools and resources, on July 26, 2012, the U.S. Department of Health and Human Services ("HHS") Secretary Kathleen Sebelius and Attorney General Eric Holder announced the establishment of a Fraud Prevention Partnership (the "Partnership").

The initiative aims to foster voluntary collaboration between the federal government, state officials, several leading private health insurance organizations, and other health care anti-fraud groups.  Specifically, the cooperating offices and organizations will "share information while protecting patient confidentiality, to leverage critical resources, and to seek out and implement the solutions we need," said Attorney General Holder.  Further, the Attorney General explained that the Partnership plans to "work to develop and disseminate 'best practices'; to educate health care professionals and consumers on ways to identify and stop fraud; and to establish an open, ongoing dialogue about emerging trends and evolving threats throughout the national marketplace."  "Perhaps most critically, " Holder noted, "the Fraud Prevention Partnership will help to extend the extraordinary - and unprecedented - record of achievement that this Administration has established in combating health care fraud."  The achievement includes returning seven dollars to the U.S. Treasury for every dollar spent on healthcare fraud prevention over the past three years, for a total recoupment to the Treasury of $4.1 billion according to Holder.

The HHS' press release regarding the Partnership indicated that "one innovative objective of the [P]artnership is to share information on specific schemes, utilize billing codes and geographical fraud hotspots so that action can be taken to prevent losses to both government and private health plans before they occur."  The Partnership also hopes to utilize data analytics technology to "spot and stop payments billed to different insurers for care delivered to the same patient on the same day in two different cities...[and] to predict and detect health care fraud schemes."  Summarizing the goals of the Partnership Secretary Sebelius said "this [P]artnership puts criminals on notice that we will find them and stop them before they steal health care dollars...[and] thanks to this initiative today and the anti-fraud tools that were made available by the health care law, we are working to stamp out these crimes and abuse in our health care system."

The Partnership's members are expected to include some of the largest private insurance companies in the country.  The following government agencies and private organizations have joined 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 Investigation; Health and Human Services OIG; Humana, Inc.; Independence Blue Cross; Nat'l Association of Insurance Commissions; Nat'l Association of Medicaid Fraud Control Units; National Insurance Crime Bureau; NY State Office of Medicaid Inspector General; Travelers; Tufts Health Plan; UnitedHealth Group; U.S. Department of Health and Human Services; U.S. Department of Justice; and WellPoint, Inc.

Later this year it is anticipated that the operational details of the Partnership will be established, including a budget and operational priorities.  The Partnership's Executive Board, the Data Analysis and Review Committee, and the Information Sharing Committee are scheduled to have their first meetings in September.  Until then, public-private working groups will finalize the Partnership's operational structure and develop a draft initial work plan.

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