Highmark shares plans to combat fraud

Highmark Inc announced that its measures to combat fraud, waste and abuse had a financial impact of more than $100 million in 2014. The company’s Financial Investigations and Provider Review staff expects it to rise to more than $115 million in 2015.

“Highmark FIPR supports the company’s mission to provide affordable, quality health care by helping to ensure that provider reimbursements are appropriate – protecting Highmark’s and our customers’ assets. We do this by preventing, investigating and resolving incidents of health care fraud, waste and abuse,” said Highmark Vice President FIPR Kurt Spear.

The National Health Care Anti-Fraud Association estimates that 3-10 percent of dollars spent on health care is lost to fraud. With annual health care expenditures in the U.S. expected to exceed $3 trillion, the loss to fraud amounts to $90-300 billion.

Highmark FIPR successfully closed out more than 2,400 cases in 2014 through audit programs that use data analysis techniques to identify unusual claims, through coding reviews and through investigations that assess the appropriateness of provider payments. FIPR uses an internal team made up of registered nurses, investigators, accountants, former law enforcement agents, programmers and industry vendors.