New Consortium Plans Strategies to Combat Medical Fraud

June 25, 2008

The newly formed Consortium to Combat Medical Fraud, a joint project of the Coalition Against Insurance Fraud, the National Health Care Anti-Fraud Association and the National Insurance Crime Bureau, along with participation from the Federal Bureau of Investigation and Department of Justice, announced on June 24 its national agenda to pursue the perpetrators of medical fraud.

The Consortium is designed to create a more open and collaborative environment between different segments of the insurance industry to heighten the detection and prevention of health care fraud.

“Never before have different parts of the insurance system cross-pollinated to seek new ways to prevent fraud. This approach will break down barriers and increase awareness across insurance lines so that we share information and coordinate our approach more systematically,” said Louis Saccoccio, executive director, National Health Care Anti-Fraud Association.

“By unleashing this group’s collective resources against both organized crime as well as individual perpetrators, the Consortium will intensify the battle against fraud in our insurance system,” said Gary Healy, director of Operations for the Mid-Atlantic, National Insurance Crime Bureau.

Spokespersons for the new consortium insist that Insurance fraud today is the most sophisticated in the industry’s history. Organized crime, as well as individuals, set up elaborate schemes designed to attack this nation’s health care system where it is most vulnerable. This Consortium plans to address this by increasing collaboration in a number of ways such as sharing information across industry and among stakeholders, leveraging industry best practices, influencing the public policy debate and shaping the future agenda; and,
optimizing and aligning objectives of various associations.

“Criminals are smart. They leverage cutting-edge technology to probe for the soft under-belly of the health care system. As a result, we need to modernize our approach to combating them,” said Dennis Jay, executive director, Coalition Against Insurance Fraud.

To that end, the Consortium also plans specific activities such as:

* Joint educational programs designed to help property/casualty insurance and health insurance investigators learn each others techniques and strategies in order to encourage cooperation across lines of insurance in detecting and investigating fraud;

* Cross-matching claims and other types of data used by property/casualty and health insurance companies to better detect fraudulent schemes as well as collaborating to build stronger cases against criminals; and,

* Industry-wide research focused on gathering information across lines of insurance to better understand the current trends seen in insurance fraud. Specifically, the first study will focus on state medical boards to evaluate how well they are disciplining licensees who commit fraud.

Source: Consortium to Combat Medical Fraud

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