As a result of its anti-fraud efforts, WellPoint and its affiliated health plans saved almost $75 million in 2008.
The anti-fraud efforts also led to 84 case referrals to law enforcement and/or licensing agencies.
"These anti-fraud results exemplify one way we can work toward the goal of decreasing healthcare costs through careful review of healthcare charges," said Lee Arian, WellPoint staff vice president for Fraud and Abuse. "These efforts have proven successful in uncovering and eliminating significant fraudulent and abusive activity in our healthcare community."
Healthcare fraud is a serious problem that results in at least $68 billion in losses every year. This accounts for at least 3 percent of the total amount spent on healthcare annually, according to the National Healthcare Anti-Fraud Association. Healthcare fraud is dangerous as well as expensive as it can involve unnecessary and excessive surgeries, procedures and prescriptions.
WellPoint estimates that for every $1 spent in preventing and investigating fraudulent activities, the company recovers or saves $11 on behalf of its affiliated health plans' customers and members. Fraud and abuse investigations by WellPoint in 2008 led to 11 arrests and 21 criminal convictions.
The Blue Cross and Blue Shield Association also recently announced that its healthcare plans' anti-fraud investigations saved and recovered nearly $350 million in 2008, an increase of 43 percent from 2007. There were 1,087 cases referred to law enforcement agencies and licensing authorities, and 252 convictions and 140 civil actions, settlements and judgments.