CAMP HILL, Pa. — Highmark Inc.’s reports that it’s anti-fraud efforts continue to be highly effective in combating fraud, waste and abuse.
Year – Actual Savings
2012 – $58,700,000
2013 – $82,700,000
2014 – $104,700,000
2015 – $119,500,000
2016 – $148,700,000
This chart shows the financial impact that Highmark’s FIPR department has made from 2013 – 2016. The graph represents dollars recovered from medical claim reimbursements made to providers as a result of FWA, savings in the form of policy changes that have helped close risk areas for FWA, as well as prevented losses such as medical claims that have been identified as being improper FWA and have been stopped (not paid). FIPR uses the same categories to define FWA related financial impact (i.e., recoveries, savings, prevented losses) as many other payers and CMS.
Spear added that this success is accomplished through audit programs that use data analysis techniques to identify unusual claims, coding reviews and investigations that assess the appropriateness of provider payments. FIPR utilizes an internal team that includes registered nurses, investigators, accountants, former law enforcement agents and programmers, complemented by an array of industry leading vendors, to complete its objectives.
“We know we are making a significant impact and helping to protect our members,” said Spear. “Anyone can help prevent fraud by reporting suspected cases. If you know of a health care provider that is submitting inappropriate claims or someone that is abusing their health insurance benefits, report it.”
Highmark encourages individuals to report suspected cases health care fraud, waste or abuse confidentially by calling 1-800-438-2478.