Health Care Fraud Prevention Public-Private Partnership
July 26, 2012
Washington, DC
Good afternoon. I am delighted to welcome everyone as we take the next big step in our fight against health care fraud.
We are here today to launch a new kind of partnership, bringing the federal government and the country’s leading private health insurance organizations together for the very first time to prevent health care fraud on a national scale.
This is just the latest milestone in our coordinated campaign to stamp out fraud from our health care system. When President Obama took office, he asked Attorney General Holder and me to make fraud prevention a cabinet-level priority. We gave that effort a boost in 2010 with The Affordable Care Act, one of the strongest health care anti-fraud laws in American history. The law provided new resources to help law enforcement catch criminals and established tougher sentences for those who got caught.
We have also developed new tools to analyze claims in real time, so we can spot bad actors and phony claims before they can do major damage.
In the past, we followed a ‘pay and chase’ model, paying claims first – then only later tracking down the ones we discovered to be fraudulent. Now, we’re taking away the crooks’ head start. And we’re using a technology similar to the one credit card companies use to identify suspicious activity as soon as it happens. Since we have put this system in place, it has stopped, prevented, or identified millions in payments that should never have been made. And because the system is designed to get smarter over time, as it analyzes more data, it’s only going to be more effective in the future.
That’s why the partnership we’re launching today is so exciting.
Over the last 3 years we’ve stepped up both enforcement and prevention, stopping many bad claims early and saving millions for taxpayers. But we also know that fraud is taking place across the health care system – with many private insurance companies facing the same challenges that we do. In fact, many fraudsters have used our fragmented health care system to their advantage.
For example, a bad actor may bill Medicare for 8 hours of care one day, then bill two other insurance companies each for 8 hours on that very same day. Seen separately, as they are now, these billings could appear normal.
But by sharing information across payers, we can bring this potentially fraudulent activity to light so it can be stopped. Public and private payers alike -- we all have a stake in making sure cheaters don’t undermine our health care system.
We have each made great strides to protect our programs from fraudsters. But as criminals’ schemes have grown more and more sophisticated, we recognize that our efforts must evolve as well. By sharing strategies and presenting a united front, we can all go much further toward stamping out health care fraud, than any of us could on our own.
So I want to thank you all for your partnership on this historic day. This is just the beginning – an opportunity for us to develop new ways to share information and data about real fraud schemes, as well as nationwide trends and patterns in fraud and abuse.
This collaboration will allow us all to get the proper payments to the right providers more effectively, while making sure no money falls into the hands of crooks. And that will ultimately mean more resources for better care, which is something we all want.
Now I will turn things over to Attorney General Holder…
Washington, DC
Good afternoon. I am delighted to welcome everyone as we take the next big step in our fight against health care fraud.
We are here today to launch a new kind of partnership, bringing the federal government and the country’s leading private health insurance organizations together for the very first time to prevent health care fraud on a national scale.
This is just the latest milestone in our coordinated campaign to stamp out fraud from our health care system. When President Obama took office, he asked Attorney General Holder and me to make fraud prevention a cabinet-level priority. We gave that effort a boost in 2010 with The Affordable Care Act, one of the strongest health care anti-fraud laws in American history. The law provided new resources to help law enforcement catch criminals and established tougher sentences for those who got caught.
We have also developed new tools to analyze claims in real time, so we can spot bad actors and phony claims before they can do major damage.
In the past, we followed a ‘pay and chase’ model, paying claims first – then only later tracking down the ones we discovered to be fraudulent. Now, we’re taking away the crooks’ head start. And we’re using a technology similar to the one credit card companies use to identify suspicious activity as soon as it happens. Since we have put this system in place, it has stopped, prevented, or identified millions in payments that should never have been made. And because the system is designed to get smarter over time, as it analyzes more data, it’s only going to be more effective in the future.
That’s why the partnership we’re launching today is so exciting.
Over the last 3 years we’ve stepped up both enforcement and prevention, stopping many bad claims early and saving millions for taxpayers. But we also know that fraud is taking place across the health care system – with many private insurance companies facing the same challenges that we do. In fact, many fraudsters have used our fragmented health care system to their advantage.
For example, a bad actor may bill Medicare for 8 hours of care one day, then bill two other insurance companies each for 8 hours on that very same day. Seen separately, as they are now, these billings could appear normal.
But by sharing information across payers, we can bring this potentially fraudulent activity to light so it can be stopped. Public and private payers alike -- we all have a stake in making sure cheaters don’t undermine our health care system.
We have each made great strides to protect our programs from fraudsters. But as criminals’ schemes have grown more and more sophisticated, we recognize that our efforts must evolve as well. By sharing strategies and presenting a united front, we can all go much further toward stamping out health care fraud, than any of us could on our own.
So I want to thank you all for your partnership on this historic day. This is just the beginning – an opportunity for us to develop new ways to share information and data about real fraud schemes, as well as nationwide trends and patterns in fraud and abuse.
This collaboration will allow us all to get the proper payments to the right providers more effectively, while making sure no money falls into the hands of crooks. And that will ultimately mean more resources for better care, which is something we all want.
Now I will turn things over to Attorney General Holder…
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