Three Groups Announce Formation Of Consortium To Fight Health Insurance Fraud

Main Category: Health Insurance / Medical Insurance
Also Included In: Medical Malpractice / Litigation
Article Date: 27 Jun 2008 - 8:00 PDT

email to a friend   printer friendly   view / write opinions   rate article

The National Health Care Anti-Fraud Association, the National Insurance Crime Bureau and the Coalition Against Insurance Fraud on Tuesday announced the formation of the Consortium to Combat Medical Fraud, which will seek to fight health insurance fraud nationwide, CQ HealthBeat reports. The consortium, which will work with the FBI and the Department of Justice, will share information on fraud claims and investigations among health insurers, hold educational programs and conduct industrywide research.

NHCAA Executive Director Louis Saccoccio said, "Never before have different parts of the insurance system cross-pollinated to seek new ways to prevent fraud." According to Saccoccio, losses from health insurance fraud totaled about $20 billion and accounted for about 3% of the estimated $2.3 trillion spent on health care in 2007.

NCIB Executive Director Gary Healy said that losses from health insurance fraud account for about 10% of premiums paid by customers.

CAIF Executive Director Dennis Jay said that customers support efforts to fight health insurance fraud and are "very heavy proponents of punishment." He said, "We're dealing with people that are not just occasionally submitting a bad bill," adding, "These are people who are cutting corners in the financial reimbursement system," often through unnecessary surgeries or medical tests.

Additional Comments
In a statement, Robert Montemorra, chief of the FBI Health Care Fraud Unit, said, "The collaborative efforts of both the public and private sector, such as working with the NHCAA and the Consortium, is one of the tools that is available to the FBI to investigate those committing medical insurance fraud."

Steve Tyrell, chief of the Fraud Section of the Criminal Division at DOJ, in a statement said, "As more people enroll in the Medicare program and private health care plans and the amount of money spent on health care continues to rise, so too does the importance of the department's efforts to combat fraud and our cooperative efforts to increase awareness and detection of fraud" (Parnass, CQ HealthBeat, 6/24).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.

© 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved.