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OHIO'S "FRAUD SQUAD" PROGRAM DRAWS PRAISE FROM BLUE CROSS & BLUE SHIELD'S JOHN BURRY JR.

 OHIO'S "FRAUD SQUAD" PROGRAM DRAWS PRAISE FROM
 BLUE CROSS & BLUE SHIELD'S JOHN BURRY JR.
 CLEVELAND, Feb. 24 /PRNewswire/ -- Ohio's new "fast track" insurance fraud program is a great idea that will help drive down the cost of health coverage and increase the state's high percentage of insured citizens, according to John Burry Jr., chairman and chief executive officer of Blue Cross & Blue Shield of Ohio (BCBSO).
 Formation of the "Fast Track Insurance Fraud Prosecution Program" was announced last month by the state's U.S. attorneys, Joyce J. George of Cleveland and D. Michael Crites of Columbus, Ohio.
 "Individuals who victimize insurance companies and ultimately insurance policyholders throughout Ohio by acts of theft and fraud will not remain part of the Ohio insurance industry," said George.
 Burry is a financial investigations pioneer in health insurance. He formed the first such department at a Blue Cross & Blue Shield Plan when he was in Michigan and brought the concept with him to Cleveland.
 "We call our own Financial Investigations Department the 'Fraud Squad' and we introduced it in 1983," Burry said. "It has saved this corporation and our policyholders an aggregate $22 million in that time, an average of about $2.4 million a year. To say it has paid for itself literally dozens of times is to understate its effectiveness.
 "The very knowledge that it exists is a deterrent to a lot of people who might otherwise have the idea they can collect money from Blue Cross & Blue Shield of Ohio for procedures they don't perform or procedures that are medically unnecessary -- or any of a variety of scams that cost us and our customers large sums of money."
 Burry said formation of a unified anti-fraud effort among all insurers in Ohio promises to have a similar effect, not only in the health insurance industry, but in all other areas of insurance, as well.
 The statewide "Fast Track" program is a cooperative effort among federal prosecutors and investigators, the Ohio Department of Insurance, state investigators, insurance companies and private insurance fraud investigation organizations.
 It is designed to establish a flow of information about theft and fraud in the industry and to promote the swift investigation and prosecution of insurance company agents and employees or others who commit embezzlement, theft or fraud.
 U.S. attorneys George and Crites said when they announced the statewide initiative that it is intended to supplement the efforts of local prosecutors and police, not to replace them.
 BCBSO's "Fraud Squad" is headed by W. Douglas (Doug) Fowler, a former Grand Rapids, Mich. police detective.
 In 1991, investigations by Fowler's department resulted in an all-time company record 42 indictments for fraud against BCBSO. The previous high of 37 was recorded in 1987. Since it was formed, the "Fraud Squad's" work has resulted in 271 criminal indictments, with an overall conviction rate of 93 percent.
 "Including indictments, court-ordered restitution, 'hotline' recoveries and other efforts, our work saved a total of just under $3 million in 1991," Fowler said.
 The "Fraud Squad," with offices in the Cleveland and Toledo areas, operates a toll-free fraud "hotline," 800-553-1000. Fowler said the hotline draws an average of 956 calls a month and is the department's most fruitful source of fraud complaints.
 Fowler's department has gained a national reputation as a leader in the constant fight against health insurance fraud and conducted a three-day seminar last year for personnel from the FBI, Ohio Department of Insurance, state auditor's office and a number of Blue Cross & Blue Shield Plans from around the country.
 BCBSO's "Fraud Squad" concept was expanded last year into West Virginia, where the company has a consulting arrangement with Mountain State Blue Cross & Blue Shield. A financial investigator and research and documentation specialist are assigned to an office in Charleston.
 -0- 2/24/92
 /CONTACT: David Eden of William Silverman & Company, 216-696-7750, for Blue Cross & Blue Shield of Ohio/ CO: Blue Cross & Blue Shield of Ohio ST: Ohio IN: HEA SU:


KK -- CL011 -- 1965 02/24/92 14:16 EST
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Date:Feb 24, 1992
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