Final Senate bill comes up fraud-lite

Harry ReidThe final Senate health reform bill was released this evening — and for the fraud-fighting community, the 2,074-page proposal contains little in the way of “game-changing” provisions to curb health care fraud.

As expected, the bill crafted by Senate leadership carried over anti-fraud provisions from the Finance Committee proposal, but not the important elements from the measure developed by the Senate Health, Education, Labor & Pensions (HELP) Committee. The distinction is Finance ignored fraud perpetuated against the private sector while HELP embraced innovative ideas to encourage the government to collaborate with private insurers to fight a common enemy.

The fraud-fighting community pushed hard for provisions to enhance collaboration and data sharing among all entities combatting health care crime — whether it be federal, state or private insurers, even property/casualty carriers.

So now the bill heads to the floor of the Senate. Our last hope is the introduction of amendments to restore some of the strong anti-fraud provisions in the HELP bill. The next few days ought to tell whether such amendments materialize.

In the meantime, the Senate bill unveiled today does contain some useful Medicare anti-fraud measures including enhanced technology for fraud detection, an additional $100 million to combat fraud and greater authority to withhold payment from suspect providers. The bill also cracks down on shady entities selling bogus coverage by giving states more muscle to put these cons out of business.

Still, it’s disappointing the Senate leadership doesn’t see the value in taking an aggressive stand against health care fraudsters who are stealing anywhere from $68 billion to $220 billion each year, according to the FBI.

The fight goes on for now. Stay tuned.

Turn out the lights in Arizona

Fraud bureauIf you do fraud for a living and are looking for a nice warm locale to ply your trade, have I got a deal with you! Pretty soon, if things go a certain way, you can move to Arizona and have little worry about the state investigating you for scamming an insurance company. That’s because budget cutters there have their eye on closing down the fraud bureau in the insurance department to save a few bucks.

It’s bad enough that they reduced full-time employees from 14 to 4 a few months back, but now they may chuck the whole unit altogether.

The proposal is only preliminary, and might not be acted upon. But at a time when almost every indicator says fraud is on the rise — and in a state that already has a severe problem — the idea of wiping a fraud bureau off the map is distressing.

The crazy aspect about this move is that the state assesses insurers for the cost of the fraud bureau at the end of each year, so the savings would be minimal. But the damage in building a culture of fraud — not to speak of the increased insurance costs consumers will bear — would be permanent and harmful. The proposal also would eliminate investigations of suspected fraud by insurance agents, adjusters and others licensed by the insurance department. In essence, the state would devolve its regulatory scheme to third-world status.

The National Insurance Crime Bureau, the International Association of SIUs and the coalition have written to Arizona Gov. Jan Brewer urging her to resist this cutback. A joint news release also was issued today. Fraud fighters in Arizona are urged to contact the state’s insurance director and governor to let them know this is an unwise move.

Good Morning America features the Coalition

QuiggleABC-TV’s premiere morning newscast featured an excellent piece on workers compensation fraud this morning. It profiled a handful of insightful cases, including comp claimants who were caught skydiving and running a race in drag. This segment not only is entertaining, but also serves to build awareness about fraud and communicates who ends up paying for these crimes. This awareness helps to deter fraud, as well. Some people will think twice about committing fraud if they see others getting caught and punished.

The segment includes an interview with the coalition’s Jim Quiggle, who initiated the idea for the segment and provided producers with the cases that were profiled. You can view the segment here.