Inpatient Facility Coding & Compliance Alert

The Obama administration recently announced the launch of a partnership among the federal government, State officials, several private health insurance organizations, and other healthcare anti-fraud groups to prevent healthcare fraud. The arrangement is intended to combat healthcare fraud and safeguard healthcare dollars to better protect taxpayers and consumers, according to the July 26 announcement from Health and Human Services (HHS) Secretary Kathleen Sebelius and Attorney General Eric Holder.

The partnership is designed to share information and best practices in order to improve detection and prevent payment of fraudulent healthcare billings. Its goal is to enable anti-fraud information to be shared more easily with investigators, policymakers, prosecutors, and other stakeholders. It should also help law enforcement officials better identify and prevent suspicious activities and protect patients' confidential information while fighting and prosecuting illegal activities.

"This partnership puts criminals on notice that we will find them and stop them before they steal healthcare dollars," Secretary Sebelius said. "Thanks to this initiative today and the anti-fraud tools that were made available by the healthcare law, we are working to stamp out these crimes and abuse in our healthcare system."

One objective of the partnership is to share information on specific schemes, utilized billing codes, and geographical fraud hotspots so that action can be taken to prevent losses to both government and private health plans before they occur. Another potential goal of the partnership is the ability to spot and stop payments billed to different insurers for care delivered to the same patient on the same day in two different cities. A potential long-range goal of the partnership is to use sophisticated technology and analytics on industry-wide healthcare data to predict and detect health care fraud schemes.

The Executive Board, the Data Analysis and Review Committee, and the Information Sharing Committee will hold its first meeting in September. Until then, several public-private working groups will continue to meet to finalize the operational structure of the partnership and develop its draft initial work plan.

The following organizations and government agencies are among the first to join this partnership:

• America's Health Insurance Plans
• Amerigroup Corporation
• Blue Cross and Blue Shield Association
• Blue Cross and Blue Shield of Louisiana
• Centers for Medicare & Medicaid Services
• Coalition Against Insurance Fraud
• Federal Bureau of Investigations
• Health and Human Services Office of Inspector General
• Humana Inc.
• Independence Blue Cross
• National Association of Insurance Commissioners
• National Association of Medicaid Fraud Control Units
• National Health Care Anti-Fraud Association
• National Insurance Crime Bureau
• New York Office of Medicaid Inspector General
• Travelers
• Tufts Health Plan
• UnitedHealth Group
• U.S. Department of Health and Human Services
• U.S. Department of Justice
• WellPoint, Inc.