UnitedHealth Group Inc. (UNH:US) and WellPoint Inc. (WLP:US), the largest publicly traded health insurers in the U.S., agreed to share more information with regulators in an industrywide partnership with the government to root out fraud.
The initiative targets theft of doctors’ identities and overbilling, including in Medicare, the $500 billion U.S. health insurance program for the elderly and disabled. The partnership may lead to sharing billing claims data, which could be mined for aberrations, said Richard Migliori, executive vice president of health services for Minnetonka, Minnesota-based UnitedHealth.
“There are mutual interests here in doing a better job at detecting what’s probably some $80 billion-plus per year in fraudulent payments across private and public sectors,” Migliori said in an interview. “There’s lot of enthusiasm for doing this right.”
Today’s announcement falls short of a full data-mining agreement, a long-range goal that the government said would help spot fraud such as when doctors charge different insurers for care delivered to the same patient on the same day in two different cities. There are obstacles to providing that information, particularly patient privacy and confidentiality concerns related to sharing claims data, Migliori said.
Health and Human Services Secretary Kathleen Sebelius, Attorney General Eric Holder and insurance industry leaders will discuss the partnership at 1 p.m. local time at the White House in Washington.
“This partnership puts criminals on notice that we will find them and stop them before they steal health care dollars,” Sebelius said in a statement.
The collaboration includes America’s Health Insurance Plans, the industry’s main lobby group in Washington, and the Blue Cross Blue Shield Association, which represents state Blue Cross and Blue Shield plans. Along with UnitedHealth, Humana Inc. (HUM:US) and Amerigroup Corp. (AGP:US) are among companies participating, according to the government.
The Justice Department has estimated that Medicare and Medicaid, the health system for the poor, are plagued by at least $60 billion in fraud a year. The Government Accountability Office, the investigative arm of Congress, reported in 2009 that an increase in bills from several states for home health care was partly because of “fraudulent and abusive practices.”
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