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Home / News & IndustryManaged Care Insight and Analysis
Updated: September 15, 2009
$350 Million Recovered in 2008 Blue Cross And Blue Shield Anti-Fraud Investigations

Five Blue Cross and Blue Shield (BCBSA) companies were recognized this year for their innovative anti-fraud efforts in recovering $350 million in savings; a 43 percent increase in recovery from 2007.

From 2007 to 2008, the number of cases opened by BCBSA National Anti-fraud Department (NAFD) increased by about 34 percent and closed cases increased by about 43 percent.

The National Healthcare Anti-Fraud Association estimates that about 3 percent of all healthcare spending ($68 billion) is lost to healthcare fraud annually. The combined savings and return for all BCBS companies' anti-fraud units was about $7 to every $1 spent on anti-fraud efforts.

"Our statistics are a direct reflection of the private sector's success at rooting out fraud and abuse- savingsignificant healthcare dollars and protecting consumers from unnecessary or even harmful medical care," said president and CEO of BCBSA, Scott P. Serota.

The following are the distinguished companies and a brief description of their unique anti-fraud programs or thorough investigations which won them recognition:

  • Blue Cross and Blue Shield of Illinois, for an Improper Billing Investigation;
  • Independence Blue Cross, Pennsylvania, for an Investigation of Cooking the Books;
  • Highmark Inc., Pennsylvania, for an Investigation in to Noncovered Procedures;
  • Anthem Blue Cross, California, for Program: Phantom Durable Medical Equipment and Labs & Program: Operation Pillbox; and
  • Blue Cross and Blue Shield of Florida for their Program regarding Questionable Manipulation under Anesthesia.

Address: Blue Cross and Blue Shield Association, 225 North Michigan Avenue, Chicago, IL 60601; (800) 892-2803,

  This article was taken from:
The Executive Report on Managed Care

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