Federal healthcare fraud initiative will vigorously scrutinize provider claims

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Health and Human Services Secretary Kathleen Sebelius
Health and Human Services Secretary Kathleen Sebelius
A new federal fraud-fighting initiative will apply increased scrutiny to provider health claims submitted to both government and private payers, government officials announced Thursday.

The public-private partnership, which joins the U.S. Department of of Health and Human Services with private insurers and federal investigators, will create an extensive database of claims data, according to HHS Secretary Kathleen Sebelius.

In remarks delivered at the White House, Sebelius explained healthcare providers often fraudulently bill Medicare and a beneficiary's private insurer for the same service.

“Seen separately, it does seem like legitimate, realistic claims,” Sebelius told reporters. “By sharing information across payers we can bring this potentially fraudulent activity to light.”

Officials have yet to announce a budget for this project, and critics point out that other healthcare fraud initiatives, such as Medicare's audit contractors, have had mixed results. And, it may take a while before law enforcement can access claim sharing data due to difficult legal and technical issues, the Associated Press reported.

Trade groups such as America's Health Insurance Plans and the Blue Cross and Blue Shield Association, as well as insurers United and WellPoint, have signed on with the partnership. The Federal Bureau of Investigation, the Health and Human Services Inspector General's Office, the Justice Department, and state fraud control units will also be included in the initiative.

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