March 14, 2013
Testimony focuses on the impact of fraud prevention on healthcare cost and quality
Darrell Langlois, vice president of Compliance, Privacy and Fraud for Blue Cross and Blue Shield of Louisiana, testified at a recent hearing of the U.S. House Energy and Commerce Subcommittee on Health on strategies for fighting waste, fraud and abuse in the healthcare system.
Langlois is a nationally recognized expert on fighting fraud, having served on the board of the National Health Care Anti-Fraud Association and on a special Anti-fraud Strike Force established by the Blue Cross and Blue Shield Association in 1994. Now called the Blue Cross and Blue Shield National Anti-Fraud Department (NAFD), this group helps educate physicians, healthcare providers and customers on how they can help with healthcare fraud detection and prevention.
Blue Cross and Blue Shield of Louisiana has operated a dedicated fraud unit since 1992, and its staff works with the Association as well as local, state and federal law enforcement to help them investigate and prosecute alleged healthcare fraud. As an example, the Louisiana State Police has an Insurance Fraud Bureau, and the company works very closely with them.
“Being a local entity allows us to have outstanding relationships with law enforcement, prosecutors and others that see and find healthcare fraud,” Langlois says. “These relationships allow us to spot fraud quicker and more often than many other health plans and results in better performance for our customers.”
Langlois emphasized in his testimony (download a PDF copy here) that fraud has far-reaching implications for both healthcare cost and quality, and that Blue Cross and Blue Shield of Louisiana is continually developing new and innovative strategies to identify fraud and halt practices that lead to substandard care. He noted that the company has adopted a three-part approach to tackling fraud:
Blue Cross President and CEO Mike Reitz said he had heard from many Capitol Hill colleagues that Langlois’ testimony had a major impact. “Darrell was terrific as expected,” Reitz said. “His ability to reach out across America and to speak effectively in front of Congress gets results.”
In his testimony, Langlois also expressed concern that the regulations for the new medical loss ratio (MLR) requirements allow health plans to count only the recovery portions of anti-fraud initiatives as non-administrative expenses, while failing to recognize that fraud prevention programs play a key role in advancing quality improvement. During the Q&A portion of the hearing, Langlois responded to several questions from Subcommittee Chairman Joseph Pitts (R-PA), who raised concerns about the MLR requirements working at cross purposes with fraud prevention efforts and not recognizing the value of provider credentialing.
Other witnesses testified on behalf of the Centers for Medicare & Medicaid Services, the Government Accountability Office and a law firm that specializes in False Claims Act litigation.
Langlois’ efforts and those of his staff are key to keeping healthcare costs in check. Fraud is considered one of the major drivers of healthcare costs, with an estimated 3% of healthcare expenditures lost to fraud each year—or about $70 billion. That amount costs the average family of four more than $200 per year over what they would pay for the honest delivery of healthcare goods and services. Learn more about the national impact of fraud on the Association’s microsite, Understanding Healthcare Fraud.
At Blue Cross and Blue Shield of Louisiana, trained investigators monitor possible fraud using sophisticated computer software specifically designed to identify potentially fraudulent activities. They cooperate actively with criminal investigations conducted by federal, state and local authorities. The company’s special investigations unit encourages confidential and anonymous tips of possible fraud.
“Blue Cross is strongly committed to our mission of providing affordable access to quality healthcare, and fighting fraud is key to that work,” Reitz says. “You, the member, can make the biggest difference by reporting unusual activity to our Fraud Hotline at (800) 392-9249.”
About Blue Cross and Blue Shield of Louisiana
Founded in New Orleans in 1934, Blue Cross and Blue Shield of Louisiana is a private, fully taxed mutual company, owned by policyholders—not shareholders. It is an independent licensee of the Blue Cross and Blue Shield Association and is governed by a Louisiana Board of Directors.
The company and its subsidiaries provide group and individual health insurance plans, life and disability insurance, group voluntary products and administrative services to Louisiana residents. With headquarters in Baton Rouge and eight district offices around the state, Blue Cross and Blue Shield of Louisiana is committed to improving the lives of its customers by providing them with health guidance and affordable access to quality care.
Learn more on the company’s website at www.bcbsla.com or visit its social media hub to connect via Facebook, Twitter and more.
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