On Thursday, the Obama administration and health insurance executives announced a new initiative designed to reduce health care fraud by pooling resources and using data analysis techniques to sift through claims data, the AP/San Francisco Chronicle reports (Smith/Alonso-Zaldivar, AP/San Francisco Chronicle, 7/26).
HHS Secretary Kathleen Sebelius in a statement said, "This partnership brings together the resources and best practices of government and private sectors, giving us an unprecedented ability to detect and stamp out health care fraud."
How It Would Work
Under the initiative -- called the National Fraud Prevention Partnership -- the federal government would hire a "trusted third party" to mine claims data collected from insurers.
Federal investigators would be able to share with insurers the names of health care providers and suppliers being investigated for fraud. Furthermore, investigators and insurers would:
- Share information on the latest trends in health care fraud; and
- Share data analysis tools used to search through claims information from Medicare, Medicaid and private insurers to identify abnormal and suspicious billing patterns.
An administration official working on the project said separate analyses of such billings would never reveal the potential fraud. The official said, "The more claims data we have, the more effective we can be in analyzing and using it."
Participants in the Partnership
Among the insurers expected to participate in the new venture are:
- Amerigroup;
- Humana;
- UnitedHealth; and
- WellPoint.
Participating lobbying organizations include:
- America's Health Insurance Plans; and
- BlueCross BlueShield Association (Pear, New York Times, 7/25).