Administration Joins Insurers To Hit Health Fraud

MARK S. SMITH

WASHINGTON (AP) ⿿ The Obama administration is upping the ante in the fight against health care fraud, joining forces with private insurers and state investigators on a scale not previously seen in an attempt to stanch tens of billions of dollars in losses.

Announcing the new public-private partnership Thursday, Health and Human Services Secretary Kathleen Sebelius said it "puts criminals on notice that we will find them and stop them."

Fraud is an endemic problem plaguing entitlement programs like Medicare and Medicaid as well as private insurance companies. Sebelius said the new program will collate claims data from all those programs and mine it for signs of bogus billing.

"Lots of the fraudsters have used our fragmented health care system to their advantage," Sebelius told reporters during a White House meeting with insurance executives. "By sharing information across payers, we can bring this potentially fraudulent activity to light so it can be stopped."

The agreement is also unusual because it brings the Obama administration and longtime foes in the insurance industry together to tackle a common problem. While carrying out the requirements of President Barack Obama's health care overhaul law, insurers are also lobbying to roll back some of its provisions, such as new taxes on the industry and cuts to private plans offered through Medicare. Obama continues to rail against industry "abuses."

But industry leaders stressed that combating fraud is in everyone's interests.

"It's just gotten a great deal harder to prey upon the public," said Karen Ignani, CEO of America's Health Insurance Plans, one of a number of industry groups backing the partnership.

Attorney General Eric Holder, who took part in the announcement, said industry and government will "come together as never before to share information while protecting patient confidentiality."

Details of the collaboration remain to be worked out, but the possibilities include sharing information on new fraud schemes as they pop up, using claims data to catch scams such as payments billed to different insurers on the same day for care purportedly delivered to the same patient in different cities, and using computer analysis to spot emerging patterns of fraud.

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