Public-Private Partnership to Prevent Health Care Fraud

HHS launched a program to stamp out health care fraud with the cooperation of the federal government, state officials, private health insurance organizations, and other health care anti-fraud groups. One objective is to share information on schemes, utilized billing codes, and geographical fraud hotspots. Another goal is to stop payments from being billed to different insurers for care delivered to the same patient on the same day in two different cities. A long-range goal is to use industry-wide healthcare data to predict and detect health care fraud.

The Executive Board, the Data Analysis and Review Committee, and the Information Sharing Committee will hold their first meeting in September. Until then, several public-private working groups are developing an initial work plan.

The partnership builds on tools provided by the Affordable Care Act, resulting in: tougher sentences for people convicted of health care fraud. Criminals will receive 20% to 50% longer sentences for crimes that involve more than $1 million in losses. There will also be enhanced screenings of Medicare and Medicaid providers and suppliers. The administration’s efforts, so far, have resulted in a record-breaking $10.7 billion in recoveries of health care fraud over the past three years. For more information, visit:www.stopmedicarefraud.gov

Last Updated 7/11/2017

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