BCBSA & anti fraud 05 26

To: BUSINESS, HEALTH, AND LEGAL AFFAIRS EDITORS

Contact: Kelly Miller of Blue Cross and Blue Shield Association, +1-202-626-4825, [email protected]

Anti-fraud savings and recoveries increase 47 percent over 2008

WASHINGTON, May 26 /PRNewswire-USNewswire/ --Blue Cross and Blue

Shield companies' anti-fraud investigations resulted in overall

savings and recoveries of more than $510 million in 2009, according to

data released today by the Blue Cross and Blue Shield Association

(BCBSA).  This represents a significant increase compared to 2008, and

contributed to a three-year average return of $7 dollars for every $1

dollar spent on anti-fraud efforts.

BCBSA released the findings from its annual survey at a press briefing

highlighting the Blue system's commitment to fighting healthcare fraud

in an effort to save healthcare dollars and protect consumers.

"Blue Cross and Blue Shield companies are achieving significant gains

in the war against healthcare fraud," said Scott P. Serota, CEO and

president of BCBSA.  "Blue companies are actively identifying and

pursuing healthcare fraud in partnership with federal and state

authorities, law enforcement, and licensing boards.  These efforts

protect consumers' healthcare safety and safeguard healthcare

affordability.  Aggressive anti-fraud investigations help ensure

critical healthcare dollars are being spent appropriately."

Joining Serota at the briefing were Peter Budetti, MD, JD, deputy

administrator, Center for Program Integrity, Centers for Medicare &

Medicaid Services; Greg Anderson, vice president, corporate and

financial investigations, Blue Cross and Blue Shield of Michigan;

Alanna Lavelle, director of investigations, WellPoint, Inc. Southeast

and Central regions; and Lou Saccoccio, executive director, National

Health Care Anti-Fraud Association.

The Blues have long maintained robust anti-fraud efforts as part of

their commitment to improve the accessibility and affordability of

healthcare services.  The recent healthcare reform debate shed light

on the importance of these efforts, and the Blues' work complements

the anti-fraud activities of the Department of Health and Human

Services.

"Finding, reducing and preventing healthcare fraud in Medicare,

Medicaid, CHIP and the private healthcare system is a high priority,"

said Peter Budetti, MD, JD, deputy administrator, Center for Program

Integrity, Centers for Medicare & Medicaid Services (CMS), Department

of Health and Human Services.  "Today's announcement emphasizes the

value of these combined efforts to help reduce healthcare fraud and

provides a sentinel effect of putting those inclined to commit fraud

on notice."

Blue Cross and Blue Shield companies' anti-fraud investigators

collectively prevented more than $318 million from being paid to

fraudulent or erroneous medical claims, an increase of 62 percent over

2008.  In addition, the Blues' efforts resulted in the recovery of

more than $192 million that had been paid to fraudulent and abuse

claims - an increase of 28 percent from the previous year.

Other statistics from the BCBSA survey include:

-- 5,028 complaints were received by Blue anti-fraud hotlines;

-- 1,044 cases were referred to law enforcement officials;

-- 490 arrests and/or indictments resulted from Blue Plan referrals;

and

-- 355 criminal convictions resulted from Blue Plan referrals in 2009.

"Coordination with state authorities and local law enforcement is a

key focus of Blue Cross and Blue Shield companies' anti-fraud

efforts," said Anderson, vice president for corporate and financial

investigations and member of BCBSA's National Anti-Fraud Advisory

Board.  "These efforts yield significant results and help defeat the

sophisticated efforts of many fraud schemes.  In addition, an educated

public is a huge boost to investigations.  We urge anybody with

information concerning potential healthcare fraud to call the national

hotline number."

Lavelle concurred, adding, "A close working relationship between

public and private investigators is crucial to the rapid

identification of fraudulent activities and subsequent, systematic

action to ensure that critical resources are not diverted from the

system."

Saccoccio urged consumers to take a more active role in preventing

healthcare fraud by reading and understanding their Explanation of

Benefits (EOB) and protecting their health insurance information.

 "Consumers are the first line of defense in the battle against

healthcare fraud," he explained.  "They need to recognize and report

possible fraud when they are being billed for services they never

received or services which are incorrect.  Their vigilance is crucial

in fighting healthcare fraud."

Blue Cross and Blue Shield 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/bcbs-companies-2009-aggregate-anti-fraud-statistics/.

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 nearly 100 million members - one-in-three of all 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 and Blue Shield Association

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