Health Care Service Corporation's Anti-Fraud Efforts Showcase Insurers' Role in Protecting Employers' and Health Plan Members' Health Care Spending

Jun 30, 2009, 15:00 ET from Health Care Service Corporation

Amount of fraud in the system serves as cautionary note for proposed $1 trillion tied to reform

CHICAGO, June 30 /PRNewswire/ -- Eliminating fraud in the health care system has emerged as a key common component of the various health care reform proposals being debated in Washington, especially as concerns grow about finding enough funding to pay for reform and ensuring that billions of dollars in new spending aren't lost to fraudulent activity.

The unparalleled ability to successfully combat fraud is one of the vital contributions to the health care system that the private health insurance sector makes, and among the most successful in fighting fraud has been Health Care Service Corporation (HCSC), the country's fourth largest health insurer and operator of the Blue Cross and Blue Shield plans in Illinois, New Mexico, Oklahoma and Texas.

Recently, HCSC's Special Investigations Department uncovered a scheme involving fraudulent Medicare and private health insurance claims totaling $800,000, a case that resulted in $2.5 million in fines and restitution. The case involved an Illinois allergist whose office was billing for non-rendered services, unbundling services and balance billing members whom the office threatened to turn over to collection agencies if the members didn't pay.

In addition to providing millions of dollars in savings for its customers, HCSC's investigation protocol has been recognized by the Blue Cross and Blue Shield Association as an industry model of how a health plan and law enforcement authorities can work together to identify and end fraudulent claims activity.

About Health Care Service Corporation

Health Care Service Corporation is the country's largest customer-owned health insurer and fourth largest health insurer overall, with 12.4 million members in its Blue Cross and Blue Shield plans in Illinois, New Mexico, Oklahoma and Texas. A Mutual Legal Reserve Company, HCSC is an independent licensee of the Blue Cross and Blue Shield Association. HCSC has a rating of AA- (Very Strong) from Standard and Poor's, Aa3 (Excellent) from Moody's and A+ (Superior) from A.M. Best Company. For more information, visit

SOURCE Health Care Service Corporation