Blue Cross sleuth says health care fraud is increasing
Published: 2009-09-27 23:13:26
Author: Jay Greene | Crains Detroit | September 6, 2009
At Blue Cross Blue Shield of Michigan, Greg Anderson, vice president of corporate and financial investigations, has been tracking down health insurance fraud for more than 27 years.
In 1980, the Michigan Blues created the first anti-fraud unit in the nation within the Blue Cross Blue Shield Association family, Anderson said.
“We were a pioneer in the field and worked very closely with the FBI, Secret Service and the U.S. Attorney's Office to pool resources and to attack the health care fraud problem,” Anderson said.
Over nearly 30 years, the Michigan Blues have identified more than $267 million in fraud, or about $14 million per year. Nationally, Blue Cross companies recovered or saved nearly $350 million in 2008, an increase of 43 percent from 2007.
“My personal opinion is that (health fraud) is increasing,” Anderson said. “We have experienced an increase of information coming our way the last couple years as our economy has changed.”
Each year, Blue Cross refers about 150 cases to law enforcement for additional investigations or prosecution.
“Our plate is always full. We have a limited capacity to receive and investigate cases, but we work very closely with government investigators,” he said.
Blue Cross, which has a 40-member anti-fraud staff that includes 23 investigators, works closely with the Detroit Medicare Health Care Fraud Task Force, which is part of national Health Care Fraud Prevention & Enforcement Action Team, or HEAT.
“One of the things that impressed me is the commitment (at the Blues) to treat (subscriber's) money as it was their own,” said Anderson, who also spent 11 years as an undercover narcotics detective with the Michigan State Police. “In the early days, there was considerable amount of pressure to investigate doctors. We never once backed away from the table because of pressure.”
But when the terrorists struck on Sept. 11, 2001, Anderson said health care fraud became a lower priority than domestic terrorism.
“We are now refocusing our resources, and there is a concerted effort between different agencies to go after health care fraud again,” he said.
Full story
Published: 2009-09-27 23:13:26
Author: Jay Greene | Crains Detroit | September 6, 2009
At Blue Cross Blue Shield of Michigan, Greg Anderson, vice president of corporate and financial investigations, has been tracking down health insurance fraud for more than 27 years.
In 1980, the Michigan Blues created the first anti-fraud unit in the nation within the Blue Cross Blue Shield Association family, Anderson said.
“We were a pioneer in the field and worked very closely with the FBI, Secret Service and the U.S. Attorney's Office to pool resources and to attack the health care fraud problem,” Anderson said.
Over nearly 30 years, the Michigan Blues have identified more than $267 million in fraud, or about $14 million per year. Nationally, Blue Cross companies recovered or saved nearly $350 million in 2008, an increase of 43 percent from 2007.
“My personal opinion is that (health fraud) is increasing,” Anderson said. “We have experienced an increase of information coming our way the last couple years as our economy has changed.”
Each year, Blue Cross refers about 150 cases to law enforcement for additional investigations or prosecution.
“Our plate is always full. We have a limited capacity to receive and investigate cases, but we work very closely with government investigators,” he said.
Blue Cross, which has a 40-member anti-fraud staff that includes 23 investigators, works closely with the Detroit Medicare Health Care Fraud Task Force, which is part of national Health Care Fraud Prevention & Enforcement Action Team, or HEAT.
“One of the things that impressed me is the commitment (at the Blues) to treat (subscriber's) money as it was their own,” said Anderson, who also spent 11 years as an undercover narcotics detective with the Michigan State Police. “In the early days, there was considerable amount of pressure to investigate doctors. We never once backed away from the table because of pressure.”
But when the terrorists struck on Sept. 11, 2001, Anderson said health care fraud became a lower priority than domestic terrorism.
“We are now refocusing our resources, and there is a concerted effort between different agencies to go after health care fraud again,” he said.
Full story