Yesterday, the Governor of New York State announced that the state has greatly exceeded its targeted health care fraud recovery quotas for 2008. Under the Federal-State Health Reform Partnerships – “a federal program that sets requirements for Medicaid fraud and abuse recoveries,” the Office of the Medical Inspector General (OMIG) for New York State agreed to a recovery target of $215 million (USD) in 2008. According to yesterday’s announcement, OMIG succeeded in recovering double the target amount, totalling $551 million (USD).

“This is a significant achievement when you consider that the total recovery for all 50 states in 2007 was 305 million (USD)”, said Medicaid Inspector General James Sheehan.  OMIG employs data mining, as well as more traditional investigatory techniques, to reveal health care fraud and overpayments against Medicaid.

OMIG has achieved these remarkable results by working cooperatively with many other state and federal government departments in the health care sector. The exercise successfully illustrates the value of strategic partnerships and target-driven objectives for the reduction of health care fraud.

Today marks International Anti-Corruption Day. This is a United Nations initiative that began in 2003 and is designed to raise awareness about corruption and the role of the United Nations Convention Against Corruption in combating and preventing it. The United Nations Office on Drugs and Corruption (UNODC) leads and administers the campaign each year.

The aim of UNODC’s 2008-2009 anti-corruption communication campaign is to support this positive and pro-active stance against corruption. The United Nations Convention against Corruption will be promoted as the key tool to fight corruption worldwide and as the impetus for a global and forceful movement.

Countries world wide will be participating in this initiative by holding events to raise awareness about corruption, including conferences and seminars.

Time and again, awareness has been shown as the single most effective way of preventing and detecting fraud and corruption. With that in mind, the CHCAA encourages Canadians to take part in the upcoming Fraud Prevention Month taking place throughout the month of March 2009. This is a fantastic opportunity for people to learn about the different types of fraud that may threaten them and strategies to help avoid becoming a victim.

People were talking fraud instead of football for a change at St. James’ Park, home of the famed Newcastle United soccer club. On November 20th and 21st, the hallowed football shrine played host to the first annual conference of the Health Insurance Counter Fraud Group (HICFG). Similar to CHCAA, HICFG is an association of British health insurance organizations committed to “working together to pool [their] resources and knowledge to drive fraudsters out of [the health care] industry” (2008 HICFG Conference Motto).

Participants included investigators from insurance companies, the anti-fraud section of the British National Health Service (NHS), health care providers, and law enforcement.

The CHCAA was pleased to be given the opportunity to tell the story of health care fraud from a Canadian perspective on the second day of the two-day event. It was evident that similarities between the British and Canadian health care systems mean that we have a lot in common when it comes to fraud. Other topics covered at the conference included data mining, investigative case studies, and a very interesting – and at times visually explicit – exploration of the differences between functional and cosmetic plastic surgery entitled: “The interpretation of skin flaps”.

The CHCAA would like to congratulate the HICFG on the success of its inaugural conference, and we look forward to continuing to build a positive relationship between our two organizations. Conferences like this one signal a positive trend amongst health insurers across the world who have recognized the seriousness of health care fraud and the benefit of inter-organizational cooperation to combat it.

The CHCAA is committed to expanding its network of Canadian and international partners in order to get the message out about the detrimental impact of health care fraud and the need for collaboration to raise global standards of best practice in fraud prevention, detection, and investigation.