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Aug 6, 2012 by |

U.S. Department of Justice Announces Fraud Prevention Partnership

Healthcare criminals beware: the federal government is strengthening its healthcare fraud prevention tools.  On July 26, 2012, the Obama Administration announced a public-private partnership focused on improving the detection of fraudulent healthcare billings.  Under the partnership, several private health insurance organizations, anti-fraud groups, and government agencies have agreed to share claims and health care data from Medicare, Medicaid, and private insurance companies. 

This increased transparency and collaboration between private and public insurers will enable law enforcement officials to more readily identify suspicious activities and protect against private and public health insurance fraud alike.  By establishing a pathway for sharing data from the sea of insurance claims, the government can better organize and analyze data to spot fraudulent activity.  For example, data sharing may reveal double-billing schemes whereby multiple insurers are billed for the same care provided to a single patient on the same day in two different cities.  Additionally, eventually, analytics may be used to predict and detect fraudulent schemes.

The partnership reflects the Obama Administration’s broader campaign to combat healthcare fraud.  Notably, the Patient Protection and Affordable Care Act (PPACA) creates a robust framework for combatting healthcare fraud.  Among other protections, the PPACA provides increased federal sentencing guidelines for healthcare fraud offenses, increased funding for hiring new officials and agents to prevent and identify fraud, enhanced data integration among federal agencies, and enhanced screening of Medicaid and Medicare providers and suppliers.  Moreover, the PPACA includes changes the False Claims Act that broaden the ability of private actors to bring qui tam cases.

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