On July 26th, Health and Human Services (HHS) Secretary Kathleen Sebelius and Attorney General Eric Holder announced a new fraud detection and prevention program featuring a partnership between government enforcement authorities and private health insurers. In its press release, CMS noted that the program is "designed to share information and best practices in order to improve detection and prevent payment of fraudulent health care billings." Notably, the information sharing aspects of the program are intended to enable authorities to act before any payments are made with regard to potentially fraudulent schemes and to identify certain types of fraud (where, for instance, both a private and public payer are billed for the same services) that might otherwise have gone undetected until after payment was made.
As of the time of this article, few details have emerged regarding the structure or procedures of the new program. CMS's press release, for instance, notes that the "The Executive Board, the Data Analysis and Review Committee, and the Information Sharing Committee" will each hold their first meeting in September, but, prior to that "several public-private working groups will continue to meet to finalize the operational structure of the partnership and develop its draft initial work plan."
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