Health & Beauty

You Can Help Fight Health Care Fraud

October 17, 2009



(NewsUSA) – 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 million 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.

To raise awareness and engage consumers – who can play a key role in the fight
against health care fraud, BCBSA launched a new nationwide toll-free hotline for reporting
suspected fraud, at 1-877-327-BLUE. BCBSA also created a new section on its Web site focused on
anti-fraud initiatives. Visit www.bcbs.com/antifraud
for more information.

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