Humana Chairman and CEO Mike McCallister and several other CEOs of health insurance companies joined Health and Human Services Secretary Kathleen Sebelius, U.S. Attorney General Eric Holder and Karen Ignagni of America’s Health Insurance Plans (AHIP) at the White House recently to announce the creation of the Fraud Prevention Partnership (FPP), a public-private partnership to crack down on health-care fraud.
“This partnership puts criminals on notice that we will find them and stop them before they steal health-care dollars,” Sebelius said. “We are working to stamp out these crimes and abuse in our health-care system.”
No one knows the exact cost of fraud, but everyone agrees it’s significant. The FBI’s most conservative estimate puts the cost at $80 billion a year. Others believe it to be much higher. For example, Louis Saccoccio of the National Health Care Anti-Fraud Association, last year estimated that fraudulent payments to Medicare alone have reached almost $50 billion a year.
And as AHIP’s Ignagni said, “The cost of fraud can far exceed what is paid for falsified claims. It can cause real harm to patients who are intentionally exposed to radiation, invasive surgeries and medications they do not need, or suffer the lasting consequences of receiving a fraudulent diagnosis.”
The initiative is being led by HHS and includes FBI participation. It is meant to bring together the resources and best practices of government and the private sectors. The plan is to pool claims data and look for suspicious billing patterns in Medicare, Medicaid and private insurance.