National consortium formed to fight medical fraud

WASHINGTON – Industry groups and federal authorities have come together in a Consortium to Combat Medical Fraud, aiming to “aggressively pursue the perpetrators” of medical fraud and “create a more open and collaborative environment between different segments of the insurance industry to heighten the detection and prevention of health care fraud.”
The new group includes the Coalition Against Insurance Fraud, the National Health Care Anti-Fraud Association and the National Insurance Crime Bureau, along with participation from the Federal Bureau of Investigation and U.S. Department of Justice.
“Never before have different parts of the insurance system cross-pollinated to seek new ways to prevent fraud,” said Louis Saccoccio, executive director of the National Health Care Anti-Fraud Association, in a news release. “This approach will break down barriers and increase awareness across insurance lines so that we share information and coordinate our approach more systematically.”
The new group’s members said they are seeking to collaborate to fight increasingly sophisticated fraud schemes that involve not only individuals, but sometimes organized crime. They plan to share information, leverage industry “best practices,” seek to influence the public policy debate, and align the objectives of the different member associations.
“These criminals are smart – they leverage cutting-edge technology to probe for the soft under-belly of the health care system,” said Dennis Jay, executive director of the Coalition Against Insurance Fraud. “As a result, we need to modernize our approach to combating them.”
The consortium will organize joint educational programs to help insurance and health plan investigators learn each other’s strategies and encourage them to cooperate; cross-match claims data and other information from both sectors to better detect fraudulent schemes and build stronger cases against criminals; and conduct industry-wide research to better understand the current trends seen in insurance fraud. The first study, the group said, will focus on how well state medical boards discipline licensees who commit fraud.
Steve Tyrell, chief of the Criminal Division’s Fraud Section at the U.S. Department of Justice, noted in the news release that anti-fraud efforts are especially important as more people enroll in Medicare and private health plans and the amount of money spent on health care continues to rise. The Department of Justice, he said, “is committed to fighting health care fraud in both the public and private sectors,” and to cooperate to increase awareness and detection of fraud.