Anti-Fraud Efforts Reap $510 Million

Blue Cross and Blue Shield plans reveal results
Anti-Fraud Efforts Reap $510 Million
Blue Cross and Blue Shield companies' anti-fraud investigations saved or recovered more than $510 million last year, according to a new study from the Blue Cross and Blue Shield Association.

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.

About the Author

Howard Anderson

Howard Anderson

News Editor, ISMG

Anderson is news editor of Information Security Media Group and was founding editor of HealthcareInfoSecurity and DataBreachToday. He has more than 40 years of journalism experience, with a focus on healthcare information technology issues. Before launching HealthcareInfoSecurity, he served as founding editor of Health Data Management magazine, where he worked for 17 years, and he served in leadership roles at several other healthcare magazines and newspapers.




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