Private health plans are joining with public plans to try to root out fraudulent billing.
America’s Health Insurance Plans (AHIP), Washington, and the Blue Cross and Blue Shield Association, Chicago, will be teaming with organizations such as the U.S. Justice Department, the Centers for Medicare & Medicaid Services (CMS) and the Federal Bureau of Investigation (FBI) in an anti-billing-fraud effort.
The coalition also includes large health insurance companies such as Humana Inc., Louisville, Ky. (NYSE:HUM); UnitedHealth Group Inc., Minnetonka, Minn. (NYSE:UNH); and WellPoint Inc., Indianapolis (NYSE:WLP).
Some of the other members of coalition are regional or single-state health insurers; the National Association of Insurance Commissioners, Kansas City, Mo., and other groups of regulators; and at least one property-casualty insurer — Travelers.
One coalition goal is for the members to “share information on specific schemes, utilized 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,” according to officials at CMS’ parent, the U.S. Department of Health and Human Services (HHS).
Coalition members also want to gain 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.
Eventually, officials say, coalition members hope to develop and use better fraud detection analytical tools.