Independence Blue Cross Recognized for Anti-Fraud Achievements
Blue Cross Blue Shield Association awards IBC for efforts to prevent fraud, waste, and abuse
Philadelphia, PA - June 30, 2009 - Independence Blue Cross (IBC) today will be recognized by the Blue Cross and Blue Shield Association (BCBSA) for its successful identification, investigation, and support to law enforcement on health care fraud investigations. In 2008, IBC's Corporate & Financial Investigations Department (CFID), which oversees this work, recovered nearly $52 million in overpaid claims resulting from fraud, waste, or abuse. Since 2004, CFID has recovered more than $192 million in overpaid claims, and referred 325 cases to law enforcement and regulatory authorities, resulting in 86 fraud charges and 65 convictions.
The National Health Care Anti-Fraud Association estimates that about 3 percent of all health care spending — or $68 billion — is lost to health care fraud annually.
"Health care fraud and abuse are expensive and increase the cost of health care for everybody," said Karen Lessin, senior vice president, Internal Audit and Corporate Compliance at IBC. "As responsible stewards of our customers' health care dollars, it is important that we do everything we can to work with law enforcement and others to help identify and bring to justice people who knowingly abuse the health care system."
BCBSA will host a live webinar today at 2 p.m. to share anti-fraud statistics and examples from Blue plans across the nation. One case involves the investigation by IBC in southeastern Pennsylvania with the FBI and U.S. Postal Service of a gynecologist who submitted more than $600,000 in false claims and fabricated medical records. The doctor was indicted for mail fraud, among other counts, convicted, and is currently awaiting a jail sentence.
Every year, BCBSA and the Harvard Medical School Department of Health Care Policy present awards to Blue health plans that identify and promote best practices in prevention, investigation, prosecution, and fraud risk identification. Edward Litchko, senior director, CFID, said, "This is the third time in four years that IBC has been recognized for successfully combining the skill and experience of our auditors, analysts, and financial investigators to identify and investigate fraudulent matters."
Nationally, Blue Cross and Blue Shield companies' anti-fraud investigations resulted in savings and recoveries of nearly $350 million in 2008, an increase of 43 percent from 2007, according to the BCBSA.
Independence Blue Cross members can call 1-866 282-2707 to report suspected fraud, or visit www.ibx.com/about_ibc/antifraud. They can also report it through the BCBSA hotline, 1-877-327-BLUE, or website.
About Independence Blue Cross
Independence Blue Cross is a leading health insurer in southeastern Pennsylvania. Nationwide, Independence Blue Cross and its affiliates provide coverage to nearly 3.4 million people. For more than 70 years, Independence Blue Cross has offered high-quality health care coverage tailored to meet the changing needs of members, employers, and health care professionals. Independence Blue Cross's HMO and PPO health care plans have consistently received the highest ratings from the National Committee for Quality Assurance. Independence Blue Cross is an independent licensee of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield plans.
The Blue Cross and Blue Shield Association is a national federation of 39 independent, community-based and locally operated Blue Cross and Blue Shield companies that collectively provide healthcare coverage for more than 100 million individuals - one in three Americans. For more information on the Blue Cross and Blue Shield Association and its member companies, please visit www.BCBS.com.