A new partnership among the federal government, state officials, leading private health insurance organizations, and other health care antifraud groups will share information and best practices in order to improve detection and prevent payment of fraudulent health care billings.
The partnership will enable those on the front lines of industry antifraud efforts to share their insights more easily with investigators, prosecutors, policymakers, and other stakeholders. It will help law enforcement officials to more effectively identify and prevent suspicious activities, better protect patients' confidential information, and use the full range of tools and authorities provided by the Affordable Care Act and other essential statutes to combat and prosecute illegal actions.
One innovative objective of the partnership is to share information on specific schemes, such as frequently used billing codes and geographical fraud hotspots, so that action can be taken to prevent losses to both government and private health plans before they occur. Another potential goal of the partnership is the ability to spot and stop payments billed to different insurers for care delivered to the same patient on the same day in 2 different cities. A potential long-range goal of the partnership is to use sophisticated technology and analytics on industry-wide health care data to predict and detect health care fraud schemes.
Visit APTA's Compliance webpage for information and resources to help keep compliant with federal requirements.