Insurers want MLR policies to include anti-fraud efforts

April 1, 2011

One of the more popular strategies in Washington for reducing healthcare spending is to uncover fraudulent operators who bilk Medicare

For public and private payers together, the National Health Care Anti-Fraud Association (NHCAA) calculates that fraud costs the system between $75 billion and $250 billion a year.

Even more damaging is the harm to patients, NHCAA Executive Director Louis Saccoccio told the House Ways & Means Committee. Individuals often fail to get needed care or may receive harmful or unnecessary treatment from providers looking to overcharge healthcare systems.

Yet the payoff so far is just the "tip of the iceberg," say the legislators and prosecutors. And organized crime appears to be moving into healthcare fraud, attracted by the large volume of spending on healthcare and the ease of bilking the system.