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Independence Blue Cross receives national award for anti-fraud efforts

Blue Cross Blue Shield Association recognizes extraordinary noncriminal investigation

Philadelphia, PA – The Blue Cross and Blue Shield Association (BCBSA) honored Independence Blue Cross (IBC) yesterday for its successful antifraud efforts. IBC is the only Blue Cross or Blue Shield plan in the country to receive the 2012 BlueWorks Anti-Fraud Award in the non-criminal investigation category. The award was presented during a Best of Blue awards conference yesterday morning at the Orlando World Center Marriott in Florida.

BCBSA recognized IBC for its successful noncriminal investigation into an allergy and asthma medical practice. The investigation resulted in IBC recovering $845,000 and saving an additional $359,000 per year. The potential overpayment to the allergy and asthma practice was significant: more than $1.1 million for just the one procedure. The practice had mistakenly but inappropriately billed for allergy doses that it did not prepare.

IBC has received five Best of Blue Award recognition over the last several years, including four for its fraud, waste, and abuse efforts.

“We’re pleased to be recognized for our vigilant efforts to identify, investigate, and recover overpaid medical claims and protect our members and group employers from rising health care costs,” said Edward Litchko, IBC senior director of the corporate and financial investigations department. “The money we recover ultimately flows back to the true victims: our members, group employers, and the government.”

Every year, the BCBSA recognizes Blue Cross and Blue Shield plans for operational excellence and outstanding initiatives that better serve members. There are Best of Blue Awards for nine business disciplines, including anti-fraud, clinical distinction, informatics, legal and governance, and marketing and communications.

The anti-fraud Best of Blue Award honors Blue Cross and Blue Shield plans with significant or outstanding performance in preventing, detecting, investigating, and resolving matters related to health care fraud and abuse. A panel of experts from the Harvard Medical School Department of Health Care Policy, the John F. Kennedy School of Government, and the law enforcement field select the winning award entry

IBC’s anti-fraud efforts have resulted in savings and recoveries of more than $58.9 million in 2011 and an additional $6.8 million in overpaid claims that have been identified but not yet recovered. Since 2007, IBC recovered or saved more than $279 million and referred 310 cases to law enforcement and regulatory authorities, which resulted in 103 indictments and 63 convictions.

IBC members can report suspected fraud through a confidential toll-free hotline, 1-866-282-2707 (TTY/TDD 1-888-789-0429), or submit an Online Fraud and Abuse Tip Referral Form.

Earlier this year, IBC joined the newly formed Health Care Fraud Prevention Partnership, a collaborative effort between public and private organizations to combine resources and more aggressively combat health care fraud and abuse.