Blue Cross and Blue Shield companies saved or recovered $510 million in 2009 through anti-fraud efforts, according to a survey of members companies conducted by the Blue Cross and Blue Shield Association.
Fraud investigations prevented the companies from paying $318 million in bogus claims—a 62% increase over 2008 that is credited to dedicating more attention and technology resources to the problem. Based on overall survey results, the investigations allowed the companies to get back $192 million that had gone out the door.
The Blues received 5,028 complaints and referred 1,044 of them to law enforcement, leading to 355 convictions, according to the survey.
A news conference announcing the findings included comments from Peter Budetti, who in February was named deputy CMS administrator for program integrity. Budetti noted that HHS this year hosted a healthcare fraud summit aimed at pooling fraud-fighting strategies between the government and private insurers.
Budetti said the CMS is working with companies on ways to improve information sharing and analytics. “There's so much fraud out there, the more we look for it, the more we fight it, the bigger the return on our investment,” he said.
Also attending the conference was Lou Saccoccio, executive director of the National Health Care Anti-Fraud Association, an organization that includes representation from private insurance companies, government health programs and law enforcement. Saccoccio said estimates of healthcare fraud range from 3% to 10% of combined public and private spending, which reached $2.4 trillion last year.
