Navigation Links
Blue Cross and Blue Shield Companies' Anti-Fraud Units Recover and Save More Than $249 Million In 2007
Date:6/19/2008

Plan representatives call efforts key to Blue companies' stewardship of healthcare dollars

WASHINGTON, June 19 /PRNewswire-USNewswire/ -- Blue Cross and Blue Shield companies' anti-fraud investigations resulted in overall savings and recoveries of more than $249 million last year, according to data released by the Blue Cross and Blue Shield Association (BCBSA). The combined return and savings result for all Blue Cross and Blue Shield companies' anti-fraud units was $5 dollars for every $1 dollar spent on anti-fraud efforts.

BCBSA released the findings from its annual survey of Blue Cross and Blue Shield companies' anti-fraud activities at a briefing to highlight the growing problem of healthcare fraud and medical identity theft. Panelists at the briefing included Gregory W. Anderson, chair of the BCBSA National Anti-Fraud Advisory Board (NAAB) and vice president, corporate and financial investigations, Blue Cross Blue Shield of Michigan; Michael Brandt, senior manager, special investigations, Blue Shield of California; and James Quiggle, director, communications, Coalition Against Insurance Fraud.

"Blue Cross and Blue Shield companies - in partnership with consumers, law enforcement, licensing boards, and authorities - are actively identifying and pursuing healthcare fraud in an effort to assure healthcare affordability," said Byron Hollis, managing director of BCBSA's National Anti-Fraud Department. "Healthcare fraud wastes critical resources, and investigations can help make sure money is being spent on healthcare that meets consumer needs."

Blue Cross and Blue Shield companies' anti-fraud investigators collectively prevented $134 million from being spent on fraudulent or erroneous medical claims, while recouping nearly $115 million paid on fraudulent claims. Nationally, Blue Cross and Blue Shield companies' anti-fraud investigators opened 13,424 cases.

Other statistics from the BCBSA survey include:

-- Nearly 10,000 cases involving providers were investigated;

-- 654 cases were referred to law enforcement officials;

-- 274 cases were sent to professional licensing authorities;

-- 350 cases resulted in arrests and/or indictments;

-- 259 cases led to criminal convictions; and

-- Blue Cross and Blue Shield Plan customers made more than 4,000 calls to

anti-fraud hotlines.

Panelists said healthcare fraud can take on many forms. "Medical identity theft is the fastest growing form of healthcare fraud, which continues to be a major financial drain on the health system," said Brandt. According to the recently released Federal Trade Commission's 2006 Identity Theft Survey Report, 3 percent of the 8.3 million identity theft victims in 2005 had their personal information falsely used to obtain medical treatment and services.

"Consumer awareness and education is a key focus of Blue Cross and Blue Shield companies' anti-fraud efforts," said Anderson. "Coordination is also important, and Blue companies often work together on large medical identity theft cases that include different entities working together across state lines. We urge anybody with information concerning potential healthcare fraud to call the national hotline number at 1.877.327.BLUE."

Quiggle said medical identity theft can be dangerous as well as financially devastating. "Elaborate fraud rings using complicated schemes to maximize the use of stolen medical identities have become more commonplace," he said.

Panelists urged consumers to take more active roles in preventing healthcare fraud by reading and understanding their Explanation of Benefits (EOB). They also recommended that consumers check with their provider's office if there are inconsistencies on their EOB, or contact their health insurers if they have additional questions.

Blue Cross and Blue Shield Plan members can report suspected fraud through a national hotline number, 1.877.327.BLUE, and Web site (http://www.bcbs.com/blueresources/anti-fraud/report-fraud.html). In addition, a brochure for consumers, "One Problem. 300 Million Victims. What You Need to Know About Healthcare Fraud," is located at:

http://www.bcbs.com/blueresources/anti-fraud/anti-fraud-consumer-brochure.pdf. An interactive Explanation of Benefits tool is located at: http://www.bcbs.com/blueresources/anti-fraud/explanation-of-benefits.html.

The webcast of this event can be viewed on:

http://www.bcbs.com/news/bluetvradio/medical-identity-theft-forum/.

The Blue Cross and Blue Shield Association is a national federation of 39 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide healthcare coverage for more than 100 million individuals - one-in-three Americans. For more information on the Blue Cross and Blue Shield Association and its member companies, please visit http://www.BCBS.com.


'/>"/>
SOURCE Blue Cross Blue Shield Association
Copyright©2008 PR Newswire.
All rights reserved

Related medicine news :

1. Blue Cross Blue Shield of Hawaii and American Well Bring Online Care to the State of Hawaii
2. BlueCross $1.5 Million Nursing Scholarships to Ease Nursing Faculty Shortage
3. Blue Cross Blue Shield Plans Post 18.2% Decline in Operating Earnings in 2007
4. Home Care Workers, Seniors, Disabled From Across Massachusetts to Protest Poverty Wages, Lack of Health Insurance, Wednesday, June 18 at Office of Governor Deval Patrick
5. Johnson & Johnson and American Red Cross Announce Resolution of Lawsuit
6. Anthem Blue Cross and Blue Shield Foundation Donates $25,000 to Red Cross for Flood Relief Efforts in Wisconsin
7. Anthem Blue Cross Federal Employee Program Plan Honored as Best of Blue
8. S.C. BlueCross Launches Less-Costly Plans Geared to Groups Seeking More Options
9. Blue Cross Foundation Awards $528,000 in Grants to Improve Community Health
10. American Red Cross Issues Appeal for Disaster Relief Fund
11. AARP Michigan and American Red Cross Partner to Help Save Lives Through Blood Donation Drive
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:4/30/2016)... , ... April 30, 2016 , ... ... Studios. With inMotion3D Abstract users can distort and manipulate three-dimensional shapes with ease ... rotation, columns, rows, ranks, point, lines, polygons, polygon texture animation, opacity texture animation, ...
(Date:4/30/2016)... ... April 30, 2016 , ... ... News on April 4th, 2016 questioned the use of the HyProCure sinus ... as “a controversial procedure.” EOTTS-HyProCure is a minimally invasive procedure performed, when ...
(Date:4/29/2016)... ... ... In an article published April 16th on the New York ... injections, which she underwent in order to feel more at home at this year’s ... article explains that Ms. Mirmelli’s situation is not unique; many plastic surgeons say they’ve ...
(Date:4/29/2016)... ... ... On Tuesday, April 26, 2016 members of the HomeTown Health network, a network ... on SB 258, the “Rural Health Care Relief” Bill. , The bill, which was ... individuals and corporations which donate directly to a “rural hospital” in Georgia, and goes ...
(Date:4/29/2016)... ... April 29, 2016 , ... Coast Dental Fort Stewart ... at its new location in the Exchange Furniture Mall at 112 Vilseck Road in ... 50-inch Samsung Smart TV. Plus attendees will have the opportunity to meet general dentists ...
Breaking Medicine News(10 mins):
(Date:4/28/2016)... 2016 , Net Sales of $1.90 billion ... the prior year period, and an increase of 1.2% on ... EPS for the first quarter were $0.52 reported, a decrease ... an increase of 29.9% over the prior year period ... guidance for 2016 Zimmer Biomet Holdings, Inc. (NYSE ...
(Date:4/28/2016)... , April 28, 2016 Oramed ... a clinical-stage pharmaceutical company focused on the development of oral ... in the upcoming PIONEERS 2016 conference, presented by Joseph ... 2016 in New York . Nadav ... at the conference. Presentation Details:   ...
(Date:4/28/2016)... April 28, 2016  ValGenesis, Inc., the ... Solutions (VLMS) today announced that a prominent ... sufferers of chronic kidney failure has selected ... their corporate validation process. The global medical ... solution to manage their validation processes electronically. ...
Breaking Medicine Technology: