Blue Cross and Blue Shield-initiated anti-fraud investigations have recovered or saved more than $510 million in 2009, according to the Blue Cross and Blue Shield Association.
Anti-fraud savings and recoveries increased by 47 percent over 2008, BCBSA officials said, and amounts to a three-year average return of $7 for every $1 spent on anti-fraud efforts.
"Blue Cross and Blue Shield companies are achieving significant gains in the war against healthcare fraud," said Scott Serota, CEO and president of the BCBSA, at a Wednesday press conference.
"Blue companies are actively identifying and pursuing healthcare fraud in partnership with federal and state authorities, law enforcement and licensing boards," he said. "These efforts protect consumers' healthcare safety and safeguard healthcare affordability."
Peter Budetti, MD, deputy administrator for the Center for Program Integrity at the Centers for Medicare and Medicaid Services, said finding and preventing fraud in private healthcare systems and federal programs is a high priority.
"Today's announcement emphasizes the value of these combined efforts to help reduce healthcare fraud and provides a sentinel effect of putting those inclined to commit fraud on notice," he said.
According to BCBSA officials, anti-fraud investigators collectively prevented more than $318 million from being paid to fraudulent or erroneous medical claims, an increase of 62 percent over 2008. In addition, they said, the Blues' efforts resulted in the recovery of more than $192 million that had been paid to fraudulent and abuse claims – an increase of 28 percent from the previous year.
In addition, BCBSA officials said:
- 5,028 complaints were received by Blues-based anti-fraud hotlines;
- 1,044 cases were referred to law enforcement officials;
- 490 arrests and/or indictments resulted from those referrals; and
- 355 criminal convictions resulted from those referrals in 2009.