Saturday, January 30, 2010

Commissioners Participate in Discussion on How To Cut Health Care Fraud

During the recent debate on comprehensive health care in Congress, cost was one of the concerns that kept surfacing. This past week, during a National Summit on Health Care Fraud, it became apparent how fraud can take money from the health care system.

During a press conference following the all day summit in Washington on January 28, state insurance commissioners from Illinois, Kansas and Ohio detailed the days events and some of the ways they feel that state insurance regulators can coordinate their efforts with federal regulators.

Ohio Director Mary Jo Hudson pointed out that medical costs have increased 13-15% and that expenses associated with fraud has helped drive up premium expenses. In fact, Illinois Director Michael McRaith noted, fraud is responsible for 3-7% of health care costs.

Hudson said that more data sharing is needed and that both state regulators and federal regulators may each have resources that the other does not. So, she continued, sharing that data makes it easier to root out fraudulent activity.
There are a lot of separate entities trying to address the same problem, says Sandy Praeger, Kansas insurance commissioner and former president of the National Association of Insurance Commissioners, Kansas City, Mo. “There needs to be greater cooperation and data sharing to perform the job more effectively.”

Among the types of fraud commissioners said were discussed during the Summit, according to Hudson, was fake patients, increasing the cost of services, pharmaceutical fraud and performing procedures that are not necessary.
Praeger detailed a fraud discussed during the Summit during which dentists pulled teeth of children that did not need to be pulled.

The conference was hosted by U.S. Department of Health and Human Services Kathleen Sebelius and Attorney General Eric Holder. Sebelius is a former Kansas insurance commissioner and NAIC president. Work groups held sessions that focused on technology to prevent and detect health care fraud and improper payments and development of effective prevention policies and methods for insurers, providers and beneficiaries.

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