HHS and DOJ today announced that Federal law enforcement is teaming up with private insurance organizations in the fight against health care fraud. While the details of how this partnership will work are unclear, the press releases issued by both DOJ and HHS indicate that the private and public sectors will share information with each other for the purpose of detecting and preventing payments for allegedly unlawful fraudulent health care billings.
This partnership appears to be voluntary but some of the largest private insurance organizations have already committed to the endeavor. Included in this list are Blue Cross and Blue Shield, Amerigroup, and UnitedHealth. Working groups have been formed to come up with an operational structure and work plan. This will likely include directives for transmitting patient information protected by privacy laws between the public and private groups.
Our Insight. Your Advantage. This public-private partnership will almost certainly increase the number of civil and criminal fraud investigations and prosecutions. Additionally, the ability to share data between private and public entities means that providers now have to seriously worry about how an issue with private pay claims may trigger an audit or investigation of Medicare or Medicaid claims. In the past, the genesis of government investigations typically came from whistleblower lawsuits or referrals from CMS and its contractors. With this new partnership, the government just added an additional source of referrals. Please stay tuned as Husch Blackwell will continue to monitor this development.