Government, Insurers to Tackle Health Care Fraud
WASHINGTON (AP) - The government is stepping up efforts to tackle health care fraud by scrutinizing claims data from insurers and federal programs in hopes of weeding out bogus billing.
Details of the initiative were to be announced Thursday at the White House by Health and Human Services Secretary Kathleen Sebelius, Attorney General Eric Holder, and insurance executives.
The analysis of data from Medicare, Medicaid and private health plans will look for suspicious patterns and other evidence that might indicate fraud, White House officials said. A "trusted third party" would comb through the data and turn questionable billing over to insurers or federal investigators.
The plan underscores President Barack Obama’s complicated relationship with the insurance industry.
He routinely criticizes insurance companies in campaign events. Yet he relied heavily on industry support to pass his landmark health overhaul and resisted calls from within his own party to set up a "single payer" plan of government-run insurance.
Among organizations expected to join the FBI in in the anti-fraud partnership are America’s Health Insurance Plans and the Blue Cross and Blue Shield Association; both played a major role in the health care debate.
Officials said those who submit fraudulent claims often do so for both government programs and private insurance plans. Separately, such claims might not raise suspicions, but taken together they could raise a red flag, such as when a doctor bills for more than 24 hours in a day.