Anti-Fraud Efforts Reap $510 MillionBlue Cross and Blue Shield plans reveal results
The association said its 39 members generated a three-year average return of $7 for every $1 spent on anti-fraud efforts.
Anti-fraud investigators prevented more than $318 million from being paid to fraudulent or erroneous medical claims, up 62 percent from 2008, the study showed. In addition, the Blues plans recovered more than $192 million that had been paid for fraudulent claims, up 28 percent.
The study of anti-fraud activity in 2009 found:
- 5,028 complaints were received on anti-fraud hotlines;
- 1,044 cases were referred to law enforcement agencies;
- Those referrals resulted in 490 arrests or indictments and 355 criminal convictions.