In recognition of its successful anti-fraud programs and investigations, the Blue Cross and Blue Shield Association(BCBSA) presented a 2011 BlueWorks® Anti-Fraud award to Blue Cross and Blue Shield of Georgia (BCBSGa) - one of two Blue Cross and Blue Shield plans across the country to receive this honor.

"The National Health Care Anti-Fraud Association estimates that $75 billion to $250 billion is lost to healthcare fraud annually. That is why prevention, detection and investigation of healthcare fraud and abuse is more critical than ever to safeguard consumers' healthcare dollars," said Morgan Kendrick, president of BCBSGa. "Anti-fraud efforts are an important component of our commitment to improving the accessibility and affordability of healthcare services for our members."

BCBSGa was recognized for a criminal investigation it conducted that revealed excessive billing and protracted treatment times from a string of chiropractic offices. Data analysis revealed excessive billing, especially for protracted treatment times for members and their families for a particular employer group. The BCBSGa Special Investigative Unit (SIU) began a large scale investigation, which included undercover activity in order to determine how the billing differed from the treatment provided. The probe resulted in successful discovery of evidence and intent to defraud. Kickback arrangements were clearly established and the scheme resulted in actual harm to members through the depletion of their benefits. The court ordered $4 million in restitution.

"In order to reduce fraud and make healthcare safer for our members, it takes teamwork and investigative excellence. By working in collaboration with consumers and law enforcement to investigate potential fraud cases, we are protecting consumers and saving healthcare dollars," saidLee Arian, staff vice president over fraud and abuse for BCBSGa's parent company.

"Blue Cross and Blue Shield companies are having tremendous success as they work with state and federal law enforcement to combat healthcare fraud and abuse," said Scott P. Serota, BCBSA president and CEO. "Our efforts are helping to keep consumers safe, and guard against the waste of healthcare dollars."

In partnership with the Harvard Medical School Department of Health Care Policy, BCBSA, recognizes Blue Cross and Blue Shield companies through its BlueWorks program for anti-fraud investigations that have identified and promoted best practices in the areas of investigation and prosecution; fraud risk identification; and, mitigation and prevention.

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