Fraud, waste and abuse cost health plans and their members up to $270 billion annually. As those committing fraud become more sophisticated, health plans need equal sophistication to see relevant patterns in a growing sea of data. To fight improper payments more effectively, Blue Cross Blue Shield of Michigan uses SAS® Fraud Framework for Health Care, from SAS, a leader in health analytics software and services.
If improper billing isn't discovered until claims are paid, the recovery of funds is difficult. This new technology allows The Blues to use predictive analytics to detect unusual payment patterns early on and interrupt the activity, ultimately reducing losses and increasing recoveries.
Doug Cedras, BCBSM director of Corporate and Financial Investigations, and Julie Malida, SAS principal for Health Care Fraud Solutions, will be discussing the Blues’ use of advanced analytics to fight health care fraud and root out improper payments this afternoon at the National Health Care Anti-Fraud Association (NHCAA)’s Annual Training Conference (ATC) in Orlando, Fla. The session takes place from 3:10-4:10 p.m.
Blue Cross Blue Shield of Michigan became the first insurer in the U.S. to launch its own health care fraud investigations unit in July 1980. The Blues’ fraud investigation unit coordinates investigations with the FBI, the Office of Inspector General for the U.S. Department of Health and Human Services, Michigan State Police and local police departments. It also assists with state and federal prosecutions. Since 1980, BCBSM’s Corporate and Financial Investigations unit has recovered more than $325 million. If you have concerns about potential health care fraud, please contact the BCBSM toll free Anti-Fraud Hotline at 1-800-482-3787.
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