NHCAA Releases White Paper: Combating Health Care Fraud in a Post-Reform World

Oct 06, 2010, 16:03 ET from National Health Care Anti-Fraud Association

Anti-Fraud Organization Presents Seven Guiding Principles for Regulators and Policy Makers as Health Care Reform is Implemented

WASHINGTON, Oct. 6 /PRNewswire-USNewswire/ -- The National Health Care Anti-Fraud Association (NHCAA) announces the release of its new white paper, Combating Health Care Fraud in a Post-Reform World: Seven Guiding Principles for Policymakers. The public interest organization is publishing the paper in light of the renewed national focus on health care fraud as both a multi-billion-dollar crime and as an endangerment to public health. The paper concludes that the fight against health care fraud will be enhanced if measures such as increased sharing of anti-fraud information, stronger auditing procedures and greater investment in fraud-fighting programs are adopted.

"Health care fraud conservatively accounts for $70 billion, or 3 percent of national health care spending," stated NHCAA Executive Director Louis Saccoccio. "Commendably, the Obama administration and members of Congress from both sides of the aisle have made fighting health care fraud a national priority. But as the federal government and the states ramp up their anti-fraud efforts, we feel it is imperative that the resources contained in the new health care reforms are utilized to their maximum efficiency; at the same time, we must avoid enacting policies that unwittingly undermine fraud fighting efforts."

In this spirit, NHCAA recommends that the following principles guide regulators and policy makers as health care reform is implemented:

  1. The sharing of anti-fraud information between private insurers and government programs should be encouraged and enhanced.
  2. Data consolidation and real time data analysis must be at the forefront of health care fraud detection and prevention.
  3. Pre-payment reviews and audits should be increased and strengthened.
  4. Public and private health plans should be allowed to protect their enrollees by barring or expelling providers suspected of perpetrating health care fraud.
  5. Health care providers participating in fraud should be sanctioned by their respective state licensing boards.
  6. Health care provider identifier numbers should be made more secure.
  7. Investment in innovative health care fraud prevention, detection and investigation efforts and programs should be encouraged.

"An effective, well-coordinated fight against health care fraud will improve the quality of health care for all Americans," Saccoccio said. "We are making this white paper available to decision makers, as well as to the general public, in the hope that this fight is waged with these principles in mind."

The white paper can be found on NHCAA's website at: http://www.nhcaa.org/eweb/docs/nhcaa/PDFs/Member%20Services/WhitePaper_Oct10.pdf

The National Health Care Anti-Fraud Association (NHCAA) – Established in 1985 by several private health insurers and federal and state government officials, NHCAA is the only national U.S. organization devoted exclusively to combating health care fraud. NHCAA's mission is to protect and serve the public interest by raising awareness and improving the detection, investigation, prosecution and prevention of health care fraud. Since its founding, NHCAA has remained a private-public partnership with its members comprising the nation's most prominent private health insurers as well as those federal, state and local government law enforcement and regulatory agencies having jurisdiction over health care fraud.

SOURCE National Health Care Anti-Fraud Association