Anthem Blue Cross And Blue Shield Earns National Honor For Fighting Health Care Fraud
PW_AD079002
Indianapolis, Ind.—May 16, 2006—For the second consecutive year, Anthem Blue Cross and Blue Shield’s special investigations unit has received a BlueWorks® award for its efforts to root out health care fraud, a crime that costs the U.S. health care system $95 billion a year.
The BlueWorks award was presented by the Blue Cross and Blue Shield Association (BCBSA) in collaboration with the Harvard Medical School’s Department of Healthcare Policy. The BlueWorks program showcases initiatives from Blue Cross and Blue Shield plans across the country that result in keeping quality health care affordable.
“We’re honored to receive this symbol of quality that’s recognized throughout the health insurance industry,” said Cynthia Lucas, director of the Special Investigations Unit for Anthem Blue Cross and Blue Shield in Indiana, Ohio and Kentucky. “By working to eliminate fraud and abuse, we’re keeping health care costs affordable for our customers while providing them access to high quality health care.”
The Centers for Medicare and Medicaid Services estimate that of the approximately $1.9 trillion spent on health care in the U.S. in 2004, about $95 billion was lost as a result of health care fraud.
Harvard Medical School researchers and a panel of anti-fraud experts recognized Anthem Blue Cross and Blue Shield for its work in the case of Thomas E. Hoshour, an Indianapolis health care professional who specialized in substance abuse treatment at eight clinics known as Sober Life Alternatives.
In 2001, Anthem anti-fraud investigators began to suspect that Hoshour was billing insurance for services that patients never actually received during an office visit, a fraudulent practice known as upcoding. In 2003, a joint investigation was launched with Indianapolis police. After more than a dozen undercover clinical visits by law enforcement over a period of three months, it was discovered that the services received by the patients in the doctor’s office were different from the invoices that were submitted to the insurer.
As a result, Hoshour was sentenced to six years in prison, and his medical license was suspended for 50 years. He was also sentenced to 14 months in federal prison for defrauding the state’s Medicaid program.
“We would not have been successful were it not for the cooperation of Indianapolis law enforcement authorities,” said Lucas. “It’s gratifying to be part of a team that makes a difference when it comes to rooting out fraud from the health care system.”
“Health care fraud only benefits the bad guys,” said BCBSA President and CEO Scott P. Serota. “Blue Cross and Blue Shield companies across the country are leading the fight against health care fraud to protect health care quality, safety and affordability. Part of the answer is helping consumers understand the role they can play in preventing fraud. The more people know about health care fraud, the better for us all.”
Through the BlueWorks program, BCBSA and Harvard Medical School work together to evaluate Blue Cross and Blue Shield company initiatives that address health care affordability and quality. Each quarter, a panel of experts from Harvard Medical School’s Department of Healthcare Policy selects a number of Blue Plan initiatives that have proven effective in improving the affordability and quality of care. Winning programs are published in Blue Works Quarterly and promoted throughout the Blue system and the health care industry as examples that can be replicated to help keep quality health care affordable in the United States. For more information about the BlueWorks program, visit www.bcbs.com/blueworks. The Blue Cross and Blue Shield Association is an association of independent Blue Cross and Blue Shield Plans. Anthem Blue Cross and Blue Shield in Indiana is a subsidiary of WellPoint, Inc. (NYSE: WLP). WellPoint’s mission is to improve the lives of the people it serves and the health of its communities. WellPoint, Inc. is the largest health benefits company in terms of commercial membership in the United States. Through its nationwide networks, the company delivers a number of leading health benefit solutions through a broad portfolio of integrated health care plans and related services, along with a wide range of specialty products such as life and disability insurance benefits, pharmacy benefit management, dental, vision, behavioral health benefit services, as well as long term care insurance and flexible spending accounts. Headquartered in Indianapolis, Indiana, WellPoint is an independent licensee of the Blue Cross and Blue Shield Association and serves its members as the Blue Cross licensee for California; the Blue Cross and Blue Shield licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, New York (as Blue Cross Blue Shield in 10 New York City metropolitan and surrounding counties and as Blue Cross or Blue Cross Blue Shield in selected upstate counties only), Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), Wisconsin; and through UniCare. Additional information about WellPoint is available at www.wellpoint.com.
|
