Show Coverage: Insurers must compare notes on fraud

June 16, 2011

Healthcare fraud often manifests like a fad, according to Louis Saccoccio, executive director of the National Health Care Anti-Fraud Assn. Saccoccio spoke to the AHIP Institute audience about fraud on Thursday afternoon.

Healthcare fraud often manifests like a fad, according to Louis Saccoccio, executive director of the National Health Care Anti–Fraud Assn. Saccoccio spoke to the AHIP Institute audience about fraud on Thursday afternoon.

“You’ll see a trend that develops first in South Florida, and then starts to migrate across the country, changing a bit as it migrates,” he said. “The fraudsters are pretty effective as they try to pick up how payers are analyzing data, and they adjust to that so they can get around whatever edits the companies may be using.”

Because of this, it is especially important for MCOs to share information so they can get ahead of the curve, Saccoccio said. Medicare and Medicaid gather an enormous amount of data, so it’s important to encourage information sharing between private and public aspects of healthcare.

“MCOs should make sure that people who work in the special investigative units in their companies are working closely with government agencies such as the FBI, the HHS Inspector General, and also state investigators on the Medicaid side,” according to Saccoccio. “When they develop an excellent rapport with these agencies they’ll share information about what they are seeing, and at the same time get information from the agencies about what they are seeing in the same geographic markets.”

He encourages MCOs to budget money for fraud prevention.

“The return on investment is there, but you have to put resources into this to be successful. Resources in terms of sophisticated technology and the number of investigators and analysts in your company,” he said.

In recent years, in the Patient Protection Affordable Care Act and the president’s budgets, there has been a significant increase in funding for anti–fraud activities within HHS, the Department of Justice, and the FBI. Private companies need to do the same.