You Can Help Fight Health Care Fraud

Many people mistakenly think health care fraud is a victimless crime, but they are wrong. Health care fraud costs all of us - in fact, it is one of the biggest problems plaguing the health care system today.

"Americans spent more than $1.7 trillion on health care in 2003," said Byron Hollis, Blue Cross and Blue Shield Association's national anti-fraud director. "According to conservative industry experts, as much as $85 billion was lost to fraud last year."

"Every dollar lost to fraud is a dollar not available to provide life-saving treatments, drugs, research and emergency services for those truly in need," Hollis said. "It is important for consumers and providers to understand what fraud looks like and be alert for its signs in order to report it and to know that if something seems too good to be true, it probably is."

Hollis highlighted several different types of health care fraud:

* Altered or fabricated medical bills and other documents.

* Excessive or unnecessary treatments.

* Billing schemes, such as: charging for a service more expensive than the one provided; charging for services that were not provided; or charging for services included in another billing.

* False or exaggerated medical disability.

* Collecting on multiple policies for the same illness or injury.

Health insurers, employers and law enforcement agencies are working hard to minimize health care fraud. In 2003, the combined Blue Cross and Blue Shield Plans' anti-fraud efforts yielded $240 mil

ion in savings and hard-dollar recoveries, an increase of more than 52 percent from 2002.

To bolster anti-fraud efforts nationwide, the Blue Cross and Blue Shield Anti-Fraud Strike Force was recently established. This group of seasoned Blue Cross and Blue Shield fraud investigators is taking on complex, multistate criminal fraud schemes - working with the FBI and other law enforcement agencies.



By: Rick Young