Using Health IT to Ferret Out Fraud

Health IT is a key component of a new public-private effort to detect fraudulent health care billings, including a possible long-term effort to use data analytics to predict and find fraud.

The initiative was announced Thursday by Kathleen Sebelius, who heads the Health and Human Services Department, and Attorney General Eric Holder. The partnership includes federal and state organizations, private health insurers and health care anti-fraud groups.

Partners plan to share information on fraud schemes, including billing codes and “geographical fraud hot spots,” and cooperate to avert payments for the same services billed to different insurers, according to HHS.

Inaugural committee meetings, including a committee focused on data analysis and review, will launch in September. A final operational structure and initial work plan are pending.

"Health plans have prioritized reducing health-care fraud and use cutting-edge technology and sophisticated data analysis to prevent fraud from occurring in the first place rather than 'paying and chasing' after the fact,” said Karen Ignagni, president of the health insurance industry trade group America’s Health Insurance Plans, in a statement released Thursday. AHIP is one of the partners, as are several of its members. 
 
“By sharing data, information, and best practices across all payers, this partnership will ensure the public and private sectors are even better equipped to fight fraud and will provide a powerful deterrent to would-be perpetrators looking to prey on patients and steal money from taxpayers,” she said.