Health insurance frauds to face strict government actions

The latest from Washington is that the Obama administration is all up against the health care and insurance frauds in the country. Major insurance companies have decided to share important and relevant data in an attempt to put a stop to the illegalities in the area of health insurance.

Foes unite for a common cause

The government and private insurance industry have come together to eradicate the menace of fraudsters. This is quite unusual keeping in view the fact that the government and private insurers have never gone along very well with each other. Though the insurers are working with the government to curb the menace of scammers, they still haven’t brought their efforts down against the new taxes on the industry.

Public-private partnership brings hopes

Kathleen Sebelius, Health and Human Services Secretary of State, was very positive on this matter. She believes that the partnership between the government and the insurers is going to boost the fight against the scammers. The unison of the government programs and the insurance industry is going to drive all the weaknesses away from the system. The health care system has always been used by the scammers to their advantage. The strengthening of the healthcare system and sharing of valuable information with the public can help bring fraudulent matters to light. This will help put an end to the fraudulent activities going on within the system. The fact that the state investors are also part of the ongoing investigations is bringing better hopes for success.

The rise in the number of scams is not only threatening to government programs such as Medicare and Medicaid, they are dangerous to the private insurance companies as well. A lot of work remains to be done on this new partnership. This includes preparation of the budget. Results are expected between six months and a year from the launch of the program. The legal and technical issues are going to push up the duration.

Looking back

This is not the first time for the anti-fraud programs. There have been such programs before. Unfortunately, those programs have not tasted success as expected. The results have never been convincing enough. For instance, the $77-million computer system launched in summer 2011 couldn’t stop more than a single suspicious payment worth $7,591. This was quite disheartening keeping in view the fact that the system was designed to detect fraud in large numbers and even before they took place.

Challenges up ahead for the new partnership

It can never be denied that there are upcoming challenges for the new public-private partnership. There may be objections from the privacy advocates to carry out an extensive scrutiny of the claims. Similarly, doctors are not much willing to and have already stepped back on monitoring their practice patterns.

Lots of things are expected from this newly built partnership. Information on fraudulent activities and plans will be shared with the motive of catching fraudulent payments. The computer systems are expected to analyze the data patterns to spot frauds as they occur. This is going to be a great effort against insurance scams in a long time.