Federal Government and Health Insurers Team up to Crack Down on Fraud

On July 26, 2012, top officials from the Obama administration announced a partnership among the federal government, state governments and some of the largest health insurance companies to step up efforts at prosecuting those suspected of health care fraud. Officials hope to eliminate fraudulent claims by sharing information between agencies. The new program is the latest in a series of efforts by the federal government to eliminate health care fraud.

Sharing Information

Federal officials are using powers granted in the Affordable Care Act passed in 2010 to go after those who commit health care fraud. Investigators from the federal government and health insurance companies will share Medicare, Medicaid and private insurance claim information and look for suspicious patterns. Agents would begin investigations into suspected fraudulent activity and alert insurers of the doctors, hospitals and suppliers under investigation. The government and private health insurers also plan to share information about billing codes people commonly utilize in fraud schemes and geographical hotspots for fraud.

Practices that investigators would be looking for include things such as one doctor billing Medicare and private health insurance companies for working more than 24 hours in one day, billing Medicare and private health insurance companies for the same services or one patient billed for simultaneously receiving care at two different locations. Authorities believe the more information available to them, the more they can spot patterns of fraudulent activity.

Federal officials hope to begin producing results from the new initiative within six months to one year. However, many suggest that the program will have many difficulties to overcome before it can become effective, including legal issues regarding patient confidentiality and the history of mistrust between health insurance companies and the federal government. Additionally, federal officials stated that a "trusted third party" would be analyzing data from government and private insurance claims and turning over suspect claims to investigators, but the government has not decided on who that third party will be yet.

Past Anti-Fraud Efforts

This partnership is just one of the steps that the Obama administration has taken targeting health care fraud. In 2011, Medicare began using a new $77 million computer system designed to stop fraudulent payouts. Justice Department officials have also stepped up prosecution of low-level health care fraud using the authority granted in the Affordable Care Act. The government has also achieved record-setting settlements with pharmaceutical companies for marketing violations.

Consult an Attorney

The federal government has made prosecuting health care fraud charges one of its priorities, as the new partnership with private health insurance companies demonstrates. Health care fraud charges are serious matters, and the penalties for conviction can be severe. Those facing health care fraud charges should seek the assistance of a seasoned health care fraud defense attorney with experience defending these complex cases.