More Use of Public-Private Partnerships To Fight Fraud Urged by HHS Officials

  BNA’s Health Care Fraud Report™ is the go-to source for health care fraud reporting, with in-depth information on government and private enforcement actions and strategies designed to...

PHILADELPHIA—The Department of Health and Human Services Office of Inspector General is pursuing cases jointly with private insurers, U.S. attorneys' offices, and other law enforcement agencies and fostering public-private partnerships (P3s) through work groups, task forces, and a liaison with the National Health Care Anti-Fraud Association, an OIG official said June 17.

At a day-long event in Philadelphia hosted by HHS and the Department of Justice, Jennifer Trussell, director of the HHS OIG investigations unit, described the unit's efforts to promote collaboration among public- and private-sector entities fighting health care fraud.

The Philadelphia summit, the sixth in a series, focused on how public-private partnerships can advance the interests of government, health care providers, and payers in detecting and preventing fraud.

“We need innovative, creative, collaborative relationships” with the private sector, Attorney General Eric Holder told attendees, who included representatives of federal law enforcement, regulatory agencies, insurers, and consumer groups.

Holder cited as an example the health care fraud working group convened recently by Zane Memeger, U.S. attorney for the Eastern District of Pennsylvania. It brought together local health care providers, insurers, prosecutors, fraud investigators, auditors, and federal, state, and local law enforcement officials.

Case Study

As an example of a prosecution that succeeded largely as a result of such cooperation, Assistant U.S. Attorney Tanya Treadway described the case of a Kansas physician and his wife who ran what purported to be a family care practice but which boasted the state's largest number of prescriptions written for controlled substances.

The case, which had bogged down, was reinvigorated by the participation of investigators from the HHS OIG, Blue Cross Blue Shield of Kansas, and Coventry Health Care, who collaborated on the analysis of all claims data from both public and private insurers to get the complete picture they needed to move forward, Treadway said.

HHS Inspector General Daniel R. Levinson acknowledged that P3s were promoted as the hot new health care fraud control strategy once before, in the mid-1990s, when the Health Insurance Portability and Accountability Act was enacted.

But the partnership that HIPAA created between the OIG and DOJ “didn't quite take off the way we hoped,” Levinson said.

He blamed a lack of resources, the challenges of aligning different departments and agency components, and the relatively unsophisticated technology available then.

Now, Levinson said, the technology has advanced by leaps and bounds, and “there's much more of a national platform” for fighting health care fraud. “So reinventing the P3 is really very, very promising.”

By Lorraine McCarthy