Anthem Blue Cross Receives Two National Awards For Anti-Fraud Best Practices
BlueCross BlueShield Association BlueWorks Anti-Fraud Awards Honor Anthem Blue Cross Programs that Stopped Fraudulent Prescriptions, “Phantom” Service Providers
Woodland Hills, CA – June 2, 2009 – Anthem Blue Cross announced today that two of its programs for preventing and mitigating health care fraud and abuse have been recognized by the BlueCross BlueShield Association BlueWorks Anti-Fraud program. Anthem Blue Cross received two of the six awards presented this year.
The first went to “Operation Pillbox,” an investigation into a small number of physicians who were prescribing an unusually large quantity of a very strong narcotic meant to treat cancer patients with severe pain. Their research found that just 10 physicians prescribed more than a quarter of the drug in the entire state, with some patients receiving more than $200,000 worth of the medication, despite no clinical evidence that the patients had cancer. As a result of the investigation, two physicians were arrested and criminally charged. One of the physicians was linked to 13 overdose deaths among his patients. Three others surrendered or lost their medical licenses.
The second award was for rooting out “phantom providers” of Durable Medical Equipment (DME). Anthem Blue Cross investigators reviewed a General Accounting Office report listing fraudulent providers and began to proactively identify the ones in California that submitted claims to Anthem. Their work, including the use of Google Earth to identify unlikely addresses and conducting site visits for questionable providers, identified 10 percent of 500 new providers were not valid businesses. As a result, requests for new provider identification numbers dropped dramatically – thus preventing future fraud from starting.
“These two awards demonstrate the extraordinary benefits of a vigilant fraud and abuse team: protecting patient safety and removing unneeded costs from the health care system we all share,” said Leslie A. Margolin, president of Anthem Blue Cross. “We are all affected by the illegal and unethical actions of a few, but the outstanding work of this team minimizes the overall impact of a few bad actors.”
The BlueWorks Anti-Fraud Awards program identifies and promotes best practices in the areas of fraud risk identification, mitigation, prevention, investigation and prosecution. Award entries are reviewed by a panel of judges from the health care industry and the Harvard Medical School Department of Health Care Policy.
About Anthem Blue Cross
Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross names and symbols are registered marks of the Blue Cross Association.