Recently a data was published by Blue Cross and Blue Shield Association's antifraud department regarding its antifraud recovery. According to this data, in 2008, Blue Cross and Blue Shield Recovered USD 350 Millions By Antifraud Investigation. As the overall saving and recoveries amounted to a whopping USD 350 millions, it reflects an increase of 43% from the year of 2007, according to BCBSA's national antifraud department. The number of opened cases increased by almost 34 percent while the number of closed cases increased about 43 percent in the year from 2007 to 2008.
According to an estimation made by national healthcare antifraud association, the amount lost to the healthcare fraud is almost 3% annually. This 3% of total healthcare spending amounts to almost as high as USD 68 billion, they estimate. As Blue Cross and Blue Shield Recovered USD 350 Millions By Antifraud Investigation, they also estimated that spending every USD 1 in antifraud investigation by Special Investigation Units for all Blue Cross and Blue Shield companies resulted in recovery of USD 7. According to Scott P. Serota, President and CEO of Blue Cross and Blue Shield Association, in detection and pursuing of healthcare fraud incidences, Blue Cross and Blue Shield has always been a leader as their statistics claims to be in this regard. The fact that Blue Cross and Blue Shield Recovered USD 350 Millions By Antifraud Investigation reflects success of private healthcare provider at detecting and recovery of healthcare fraud, he added.
The way Blue Cross and Blue Shield Recovered USD 350 Millions By Antifraud Investigation will help eradicating healthcare fraud. This way it saves healthcare expenditure to a significant degree as well as protecting people from detrimental medical care. To facilitate and encourage proper fruitful investigation against healthcare fraud, BCBSA has formed a partnership with Harvard Medical School Department of Health Care Policy. Every year, through the BlueWorks program, they recognize different BCBS Companies' antifraud investigation programs, which are innovative in recognizing and prosecuting healthcare fraud incidences and identified as the best practices for fraud identification and prevention. For their excellence in recognizing and prosecuting the health care fraud by their innovative way, five Blue Cross and Blue Shield companies were recognized. These five independent Blue Cross And Blue Shield companies are:
- Blue Cross and Blue Shield of Illinois. Here the Blue Cross and Blue Shield investigator found a provider submitting disproportionate bills and after delving into the matter it was found that bills were submitted for not rendered services, inappropriate billing of balances, and individual parts were charged separately for a single service. While the physician had to pay USD 2.5 million as a penalty, the office managers were not spared.
- Independent Blue Cross Pennsylvania. Here independent Blue Cross investigators along with U.S. Postal Inspector and Federal Bureau of Investigation found a gynecologist guilty of submitting false claims worth more than USD 60,000.
- Highmark Inc. of Pennsylvania. Here patients were found to be billed for noncovered procedures by chiropractors having no credentials working in the provider's office. Apart from a sentence of four years in jail, the physician had to pay USD 12 million.
- Anthem Blue Cross of California.
- Blue Cross and Blue Shield of Florida.