New Public-Private Partnership Seeks to Combat Fraud

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On July 26, 2012, in further efforts to combat healthcare fraud, HHS Secretary Kathleen Sebelius and Attorney General Eric Holder announced a new partnership among the federal government, state officials, private healthcare organizations, and anti-fraud units.  The collaborative effort will unite various entities to share information and best practices to detect fraudulent healthcare billing practices that affect both public and private payers, with members of the partnership planning to share information on geographical “fraud hotspots,” commonly used billing codes, and fraudulent schemes. A number of entities have already joined the partnership, including, among others, Blue Cross and Blue Shield Association, Humana Inc., UnitedHealth Group, U.S. Department of Health and Human Services, U.S. Department of Justice, and WellPoint, Inc.  One of the keys to the new partnership is that it will seek to analyze trends in healthcare fraud to combat fraud before it occurs rather than after money has been paid.  With the partnership uniting public and private insurers against healthcare fraud, Secretary Sebelius acknowledged that the joint efforts will help combat fraud fueled by a “fragmented” healthcare industry.  A budget must still be set for this partnership, and planning efforts, which have already begun, are expected to last into the fall.  The CMS news release is available by clicking here

Reporter, Christina A. Gonzalez, Houston, +1 713 276 7340, cagonzalez@kslaw.com.