|$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 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
"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.
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, www.bcbs.com.