Printer Friendly

BLUES ANTI-FRAUD UNIT SAVES $92 MILLION SINCE 1980

 BLUES ANTI-FRAUD UNIT SAVES $92 MILLION SINCE 1980
 DETROIT, March 11 /PRNewswire/ -- Blue Cross and Blue Shield of


Michigan's (BCBSM) health care fraud investigation unit, the oldest and most successful operation of its kind in the U.S., has saved or recovered more than $92 million since it was founded in 1980.
 More than $4 million was saved or recovered in 1991 alone.
 That amount includes actual recovery of fraudulent payments, court- ordered restitution and a conservative estimate of the amount of money that would have been paid out if the anti-fraud unit had not forced an end to illegal activities.
 The unit has investigated 9,713 allegations, referred 1,407 cases to law-enforcement agencies, and developed evidence that has led to 853 warrants, 772 arrests and 592 convictions of providers, subscribers and employees.
 Since the Michigan program was founded, 28 other Blues plans have developed some type of dedicated anti-fraud activity and the private insurance industry has intensified its fraud detection efforts.
 BCBSM's anti-fraud unit is based on the premise that prosecution is the best deterrent.
 "We want to create an awareness that the chances of fraudulent activity being detected are high, and if identified, prosecution will follow," said Greg Anderson, unit director.
 Health care fraud constitutes 5 percent to 15 percent of the U.S.'s annual health care bill, according to the U.S. Chamber of Commerce. Anderson said even a small percentage of fraud should not be ignored.
 "Fraud involves only a very small number of health care providers," said Anderson, "but the dollar amount is significant enough that we have a responsibility to our customers to pursue offenders."
 Investigators work in concert with the medical community as well as law-enforcement agencies.
 "Health care providers have been supportive of anti-fraud efforts," Anderson said. "They feel the few bad apples are a disservice to the vast majority who are working to improve the quality of life."
 Telephone calls to BCBSM's toll-free, anti-fraud hotline are the starting point for most investigations.
 A routine mailing of "explanation of benefits" forms to BCBSM customers prompts 70 percent of all hotline calls. The form lists services paid by BCBSM on behalf of its customers and encourages them to report any irregularities to the hotline.
 Some 17,800 calls were received in 1991. All are investigated and about one-third warrant further investigation by the anti-fraud unit.
 "We're not a law-enforcement agency, so any information we develop must be presented to the appropriate agency which then conducts its own investigation, often in cooperation with BCBSM fraud unit members. That agency then seeks indictments or warrants as needed," Anderson explained.
 BCBSM's fraud unit is a unique combination of investigative skills. The majority have law-enforcement backgrounds in surveillance, undercover work, credit card fraud and narcotics. Others come from inside the company with experience in auditing, security and nursing.
 Anderson, a former Michigan State Police officer with extensive undercover experience, has been with the fraud unit since 1981. He is an active member of the National Anti-Fraud Advisory Board, which assists representatives of all Blue Cross and Blue Shield plans in anti- fraud efforts, including training and investigations.
 The unit has played a supportive role in the passage of landmark anti-fraud legislation in Michigan:
 -- Supported the Health Care False Claims Act of 1984 which, for the first time, made any attempt to defraud a medical insurance carrier a felony and established maximum penalties of 10 years in prison and a $50,000 fine for violators.
 -- Joined in lobbying efforts for triplicate script legislation, which requires prescriptions to be completed in triplicate for certain addictive-type drugs, and doctors, pharmacists and the state to keep records on dispensing of them.
 "Michigan is one of the top states in the nation in the volume of potentially abusable drugs dispensed," Anderson said. "After this legislation, there was a substantial decrease in the number of such prescriptions processed through BCBSM."
 Anderson and his colleagues also lobbied for legislation that, for the first time, puts health insurance cards under Michigan's state credit card statute, making it a crime to possess stolen cards or to attempt to sell or misuse cards.
 An important challenge for the future, said Anderson, is to use the limited investigative resources available to uncover fraudulent schemes that have become increasingly complex.
 "I anticipate we will be developing additional joint task forces with Medicaid and Medicare to help pool resources and prevent the shift of criminal activity from one health care area to another," Anderson said.
 Anyone with information about suspected health care fraud should telephone BCBSM's toll-free, anti-fraud hotline at 1-800-482-3787 between 8:30 a.m. and 4 p.m., Monday through Friday.
 -0- 3/11/92
 /CONTACT: Rude Difazio, 313-225-8113, or Helen Stojic, 313-225-7975, both of BCBSM/ CO: Blue Cross and Blue Shield of Michigan ST: Michigan IN: INS SU:


ML-JK -- DE026 -- 7441 03/11/92 16:10 EST
COPYRIGHT 1992 PR Newswire Association LLC
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1992 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Publication:PR Newswire
Date:Mar 11, 1992
Words:812
Previous Article:IDB COMMUNICATIONS GROUP SIGNS AGREEMENT FOR ADDITIONAL TRANSPONDER ON SATCOM C-5 FOR DATS SERVICE
Next Article:SI HANDLING SYSTEMS ACQUIRES BT SYSTEMS
Topics:


Related Articles
PENNSYLVANIA BLUE SHIELD SUPPORTS FEDERAL BILL ON MEDICARE, DURABLE MEDICAL EQUIPMENT ABUSE
FLAT ROCK DENTIST FOUND GUILTY OF FRAUD CHARGE
OHIO'S "FRAUD SQUAD" PROGRAM DRAWS PRAISE FROM BLUE CROSS & BLUE SHIELD'S JOHN BURRY JR.
BLUES ANTI-FRAUD UNIT SAVES $92 MILLION SINCE 1980
TRAVELERS SAVES $54 MILLION IN 1992 BY CRACKING DOWN ON FRAUD
Highmark's Fraud Efforts Yield Record Number Of Convictions and Indictments in 2001 and First Quarter 2002.
Anthem Blue Cross and Blue Shield Recovers and Saves More Than $32 Million Of Fraud.
Fraud Health Forum Features Key Experts From IBC and ViPS; Speakers to Lead Major Discussion on Technology and Healthcare Fraud and Abuse.
Blue Cross' Fraud Investigations Save $3 Million in 2004: Rent-a-Patient Scam Dwindles.

Terms of use | Copyright © 2016 Farlex, Inc. | Feedback | For webmasters