Blues see $350M gain from anti-fraud investigations

It's not just CMS getting down and dirty to fight fraud: A new report from the Blue Cross and Blue Shield health plans says that the group recovered almost $350 million last year through anti-fraud investigations. That's an increase of 43 percent over the prior year, the report notes.

The Blue Cross and Blue Shield Association's National Anti-Fraud Department said the recaptured funds were drawn from issues including false claims, improper billing practices and non-covered procedures. About 57 percent of fraud investigations touched on professional services and facilities, 9 percent were healthcare facilities, 12 percent related to members and 6 percent to pharmacy issues.

The group is trying to hack away at the substantial sums lost to fraud. Each year, the group estimates some 3 percent of healthcare spending is lost to fraud. Among the fastest growing areas subject to fraud is medical theft, it reported.

To learn more about these efforts:
- read this Modern Healthcare article (reg. req.)