Business
Blues plans form anti-fraud task force
■ Investigators from plans around the nation will cooperate to solve fraud cases that overlap regional boundaries.
By Robert Kazel — Posted May 10, 2004
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The national BlueCross BlueShield Assn., linking health care fraud to the rising cost of insurance coverage, has assembled a task force of fraud specialists to investigate serious criminal activities that are too big for individual plans to handle.
The Chicago-based association's new Anti-Fraud Strike Force, announced April 19 by association President Scott P. Serota, is a crisis response team made up of leading fraud investigators from throughout the 41 BlueCross BlueShield plans. The association said they will come together as needed to handle particularly serious cases of fraud by physicians, patients or hospitals. The task force will work closely with the FBI and the U.S. Dept. of Health and Human Services' Office of the Inspector General, said Byron Hollis, national anti-fraud director for the association.
Hollis is co-chairing the task force with Greg Anderson, vice president for corporate and financial investigations at Blue Cross Blue Shield of Michigan.
"Strike Force -- sounds kind of ominous, doesn't it?" said Hollis, an attorney and former Alabama deputy sheriff.
Although the group's name may conjure up images of a medical-world SWAT team, Hollis said the task force will choose its cases judiciously, convening only infrequently whenever Blues plans need help with "large cases that extend beyond a local market." Such cases would be prohibitively expensive for a single plan to investigate, he said.
Some experts estimate that insurance fraud costs Americans $50 billion a year.
The task force will go after blatant and elaborate fraud schemes, and no physician need worry that it will swoop down on minor infractions or mistakes, Hollis said. The national task force won't spend any time looking at physicians' routine decisions, such as their selection of CPT codes when billing insurers, he said.
"We don't want to waste our investigative manpower and resources on a case that is a simple mistake or misinterpretation of a payment rule that can be easily remedied," he said.
