The nation's 40 independent Blue Cross and Blue Shield plans saved and recovered a total of $228 million in 2004 through coordinated antifraud efforts, according to the national Blue Cross and Blue Shield Association. That includes $120 million recovered through court proceedings, voluntary repayments and settlements and $108 million in losses prevented through prepayment review and other stopgap measures.
The Blues' fraud-fighting efforts saved $240 million in 2003. In April 2004, the Blues association launched its own antifraud strike force to work more closely with the FBI, HHS' inspector general's office and other law enforcement agencies. The effort has included heightened consumer education and outreach initiatives, a new hotline for fraud reports and an antifraud Web site.
According to the association, the number of fraud cases referred to authorities rose 15% to 663 last year, while the number of warrants and indictments issued increased 17% to 189. Blues plans also received 80,000 hotline calls last year, up 15% over the prior year.
Government estimates peg the cost of healthcare fraud at $90 billion, or about 5% of the $1.8 trillion spent on healthcare last year.