|Federal Information & News Dispatch, Inc.|
Good morning, Chairman Pitts, Ranking Member Pallone and other distinguished Members of the Subcommittee. I am
NHCAA was established in 1985 and is the leading national organization focused exclusively on combating health care fraud and abuse. We are unique among associations in that we are a private-public partnership--our members comprise 90 of the nation's most prominent private health insurers representing over 300 corporate entities, along with nearly 100 federal, state and local government law enforcement and regulatory agencies that have jurisdiction over health care fraud who participate in NHCAA as law enforcement liaisons.
NHCAA's mission is straightforward: To protect and serve the public interest by increasing awareness and improving the detection, investigation, civil and criminal prosecution and prevention of health care fraud and abuse. Our commitment to this mission is the same regardless of whether a patient has private health coverage through an employer or as an individual, or is a beneficiary of
I am grateful for the opportunity to discuss the problem of health care fraud and abuse with you, examining options to combat it. In my testimony today, I draw upon our organization's twenty-seven years of experience examining, understanding and fighting health care fraud.
On a national level, fraud hampers our health care system and undermines our nation's economy. On an individual level, no one is left untouched by health care fraud; it is a serious and costly problem that affects every patient and every taxpayer across our nation. The extent of financial losses due to health care fraud in
Health care fraud takes many forms and is a serious problem regardless of the mode of health care delivery. Similarly, anti-fraud efforts must be multi-faceted, as there is no single solution to this problem. In my testimony today I will focus on the following five topics which NHCAA believes are critical for successfully combating health care fraud.
. First, the importance of anti-fraud information sharing and cooperation among all payers of health care, including the sharing of information between private insurers and public programs.
. Second, the critical and growing role of data analytics and predictive modeling in being able to detect fraud and potentially prevent precious health care dollars from being lost to fraud.
. Third, the importance of employing rigorous provider screening as a means for ensuring that only legitimate providers are able to submit claims for payment.
. Fourth, some of the innovative methods being applied with success to address a problem of growing concern for private insurers and public programs -- prescription drug fraud and drug diversion.
. Finally, the importance of maintaining an anti-fraud workforce that has the skills and experience necessary to meet current and future health care fraud challenges.
I. Cooperation and information exchange between public and private payers of health care is critical to the success of anti-fraud efforts and should be encouraged and enabled.
Health care fraud does not discriminate between types of medical coverage. The same schemes used to defraud