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Medicare scams spur new approach

Insurers team up with government

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Attorney General Eric Holder speaks in the Cabinet Room of the White House, Thursday, July 26, 2012, where he announced the formation of a public-private partnership to fight fraud in the health care system. (AP Photo/Susan Walsh)

Aiming to crack down on fraudulent health care claims that cost the government tens of billions of dollars each year, the Obama administration said Thursday it will begin mutually sharing claims information with private health insurers to try to spot fraud.

Attorney General Eric H. Holder Jr. and Secretary of Health and Human Services Kathleen Sebelius met with insurers at the White House to announce the effort, which they said will help Medicare and Medicaid detect and ultimately block claims from those who overbill the federal insurance programs or bill them for services never provided.

“We know that fraud’s taking place across the health care system with many private insurance companies facing the same challenges that we do,” Mrs. Sebelius said. “In fact, lots of the fraudsters have used our fragmented health care system to their advantage.”

While President Obama often has criticized insurers for “abuses” in the health care industry, in this case he is teaming up with two major insurance lobbies — America’s Health Insurance Plans and the Blue Cross and Blue Shield Association — along with insurance companies, such as Amerigroup and UnitedHealth.

The federal agencies and private insurers will share information about specific schemes, billing codes and locations around the country where fraud most frequently takes place, officials said. They said that could help them identify providers who simultaneously bill Medicare and other insurers for the same hours of work, along with other types of fraud schemes.

With Medicare fraud estimated to cost the government $60 billion a year, the administration has upped efforts to clean up the system in the last few years, assisted by provisions in Mr. Obama’s 2010 health care law that lengthened sentences for fraud and beefed up screening measures.

In February, the administration announced that its efforts to prevent fraud saved the Medicare program $4.1 billion last year — almost twice the $2.14 billion in phony claims collected in 2008. At the same time, 75 percent more individuals were charged with fraud, officials said.

Mr. Holder said the administration can keep building on its accomplishments by partnering with private companies.

“[The partnership] will strengthen our ability to protect the American people from many of the health care fraud schemes that devastate lives, undermine the integrity of our health care system and drive up costs for all consumers,” he said.

HHS officials said they don’t yet know how much the partnership will cost, but that the funding will come out of the agency’s anti-fraud funding. They said a “trusted third party” will analyze the information while protecting private patient information.

The effort represents a rare collaboration between the administration and the insurance industry, which opposes some parts of the health care law, including a new tax on premiums and cuts to Medicare Advantage. But AHIP President Karen Ignagni said sharing information is beneficial for all parties.

“Working together in our view will allow us to do four things,” she said. “Share information, identify fraud early, weed it out more quickly, protect patients from being at risk for inappropriate, substandard or wrong care.”

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Paige Winfield Cunningham
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