New Anti-Fraud Partnership Created to Fight Medical Fraud Rings

A new anti-fraud partnership uniting the public and private insurers creates a strong force multiplier and national strategy to increase upward pressure on fraud rings and downward pressure on medical premiums, the Coalition Against Insurance Fraud said.

“A dawning era of cooperation unleashes a national effort to eradicate fraud. Information-sharing is critical to stripping back the veil of secrecy allowing many fraud rings to operate. A joint effort will apply huge and hopefully fatal pressure on crime rings and their costly schemes,” said Dennis Jay, the Coalition’s executive director and a member of the new partnership’s executive board.

The Fraud Prevention Partnership was announced in Washington. The group includes auto and workers comp as part of is focus, with healthcare as a key emphasis. It is based on information sharing between public and private insurers. Increasingly, the same dishonest medical providers are defrauding private auto, workers compensation and health insurers but also taxpayer-funded programs such as Medicare and Medicaid, Jay says.

Jay congratulated HHS Secretary Kathleen Sebelius and Attorney General Eric Holder for taking this bold step. Jay urged all partners to be actively engaged in the effort’s success.

This high level of collaboration greatly increases the chances of earlier detection and successful prosecution, the Coalition said.

Over time, the coordination of anti-fraud intelligence and strategy will help shut down more medical schemes involving health, auto and workers compensation. This is true whether they’re large, national fraud rings or individual providers, Jay predicts.

Some estimates peg Medicare fraud alone at $60 billion annually in theft annually. All healthcare fraud could reach $80 billion the FBI says.

“The partnership’s timing comes at a pivotal moment. Fraud rings are surfacing that try to steal several hundred million dollars apiece. How many more mega-rings are operating, and are their huge thefts creating a new norm for defrauding health-related insurers?” Jay says.

The partnership includes Health & Human Services, the Department of Justice, the NICB, the NAIC, private health plans, property & casualty insurers and major anti-fraud organizations.

The Coalition is a nonprofit alliance of insurers, consumers and government agencies fighting all forms of insurance fraud.