The Blue Cross and Blue Shield Association announce anti-fraud efforts

The Blue Cross and Blue Shield Association (BCBSA) today announced a new Anti-Fraud Strike Force comprised of top Blue Plan investigators that will work with the Federal Bureau of Investigation (FBI) and other national, state and local law enforcement agencies to fight major insurance fraud schemes that rob consumers of millions of dollars annually.  BCBSA President and CEO Scott P. Serota announced the new initiative in a speech to the Detroit Economic Club.

 

The Association also announced plans to step up consumer education and outreach to encourage Blue Cross and Blue Shield customers across the country to report healthcare fraud.  The initiatives are part of the Blues’ ongoing efforts to protect consumers from scams and fight healthcare fraud that drives up costs.

 

“Every dollar taken by some con artist is a dollar stolen from vital services such as emergency or pediatric care,” said Serota.  “As the cost of healthcare fraud is absorbed by consumers, ultimately that’s a dollar more that families have to pay to get the healthcare they deserve. It must stop.”

 

Last year alone, Blue Cross and Blue Shield companies saved American consumers $240 million by preventing scams and recovering dollars that would have been lost to fraud.  With the new Strike Force and consumer education program in place, the Blues are stepping up efforts to protect their more than 88 million customers – nearly one-in-three Americans – across the country.

 

“Blue Cross and Blue Shield companies have invested the resources and pooled our talent to fight healthcare fraud, and we’re seeing results,” Serota said.  “But the industry as a whole still faces an enormous challenge.  We must continue working together to assure that consumers’ dollars go to quality healthcare, not criminals’ bank accounts.”

 

The National Health Care Anti-Fraud Association (NHCAA) estimates that healthcare fraud costs American consumers more than $50 billion annually.  Billing for services not rendered and misrepresentation of provided services are the most common types of healthcare fraud.

 

Comprised of top, seasoned investigators from across the Blue System, the Strike Force offers the breadth of experience and knowledge that will help Plans investigate elaborate fraud schemes that spread across numerous jurisdictions.  The Strike Force will coordinate with Plans and enforcement agencies like the FBI and the Office of the Inspector General for the Health and Human Services Department to probe suspicious activities.  It also will work with the Blue Cross and Blue Shield National Anti-Fraud Advisory Board (NAAB) and NHCAA.

 

The Strike Force will include lead investigators representing Blue Plans from around the nation, including Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Florida, Blue Cross and Blue Shield of Michigan, BlueCross BlueShield of Tennessee, CareFirst BlueCross BlueShield, Empire Blue Cross and Blue Shield, Health Care Service Corp., Independence Blue Cross, The Regence Group and WellPoint Health Networks.  The Strike Force will be co-chaired by Byron Hollis, BCBSA National Anti-Fraud director, and Greg Anderson, vice president, Corporate and Financial Investigations, Blue Cross Blue Shield of Michigan.  Hollis and Anderson also co-chair the NAAB.

 

BCBSA also announced a new consumer outreach education program to encourage individuals, physicians and other healthcare professionals to report suspicious activities.  A new national toll-free hotline – 1-877-327-BLUE – and a new consumer Web page, http://bcbs.com/antifraud, will empower consumers to act when they suspect wrongdoing. Individuals wishing to report fraud or suspicious charges or fees can access the hotline or Web site to be connected automatically to the appropriate Blue Cross and Blue Shield Plan.  All such reports will be treated confidentially.

 

BCBSA also will publish an annual “Consumer Guide on Healthcare Fraud,” for Blue Plans distribution to employer groups and consumers across the country.

 

The Blue Cross and Blue Shield Association is made up of 41 independent, locally operated Blue Cross and Blue Shield companies that collectively provide healthcare coverage for more than 88 million – nearly one-in-three – Americans.  For more information on the Blue Cross and Blue Shield Association and it Plans, please visit www.BCBS.com.