On Thursday, the Obama administration and health insurance executives announced a new partnership intended to reduce health care fraud by combining resources to share and compare claims data, the AP/San Francisco Chronicle reports (Smith/Alonso-Zaldivar, AP/San Francisco Chronicle, 7/26).
The initiative was unveiled by HHS Secretary Kathleen Sebelius, U.S. Attorney General Eric Holder and insurers.
About the Initiative
Among the insurers participating in the new venture are Amerigroup, Humana, UnitedHealth and WellPoint, as well as the lobbying organizations America's Health Insurance Plans and the BlueCross BlueShield Association, according to the Times.
The initiative, called the National Fraud Prevention Partnership, will allow federal investigators to provide insurers with the names of providers and suppliers being investigated for fraud. Furthermore, investigators and insurers will share information on the latest trends in health care fraud. They also will share tools used to search through pools of claims data from Medicare, Medicaid and private insurance to identify abnormal and suspicious billing patterns.
For example, the partnership will enable federal agents to identify a physician who bills Medicare and two private insurers for more than 24 hours of work in a single day, an administration official working on the project said. The official noted that separate analyses of such billings would never reveal the potential fraud.
Under terms of the initiative, the federal government will hire a "trusted third party" to analyze claims data collected from insurers, according to the Times.
Sebelius said the partnership combines "the resources and best practices of government and private sectors" in an effort to "stamp out health care fraud."
AHIP President Karen Ignagni called the new joint effort "a major national initiative to detect and prevent fraud." She added that similar collaborations have succeeded at the local level (Pear, New York Times, 7/25).