Fraud is a significant problem for insurers and health care
providers alike and in the European Union (EU) alone results in
losses of between €30 billion ($42 billion) and €100 billion
annually, according to Paul Vincke, president of the European
Healthcare Fraud and Corruption Network (EHFCN).
Based on the higher of the two estimates health care fraud
equals about 10 percent of total health care spending in the 27 EU
countries.
Go deeper with GlobalData
Health care fraud schemes are not confined to single countries and
have become what the EHFCN describes as “exportable” and
increasingly complex.
Against this background, the EHFCN and its counterparts in the US,
the American National Health Care Anti-Fraud Association (NHCAA),
and in Canada, the Canadian Health Care Anti-Fraud Association
(CHCAA), have joined forces to take the fight against fraud
global.
“It is essential that associations such as EHFCN, CHCAA and NHCAA
form strong relationships and network in order to deal with
potential increases in global cross-border fraud and corruption by
exchanging information on current problems and solutions,” stressed
Vincke.
Viewed by the three organisations as the basis for the development
of a broader anti-fraud network, joint initiatives will include
improvement of international standards of practice around fraud
prevention, detection, investigation and prosecution.
Adding momentum to the move to combat health care fraud the UK’s
Health Insurance Counter Fraud Group (HICFG) has signed a
memorandum of understanding with the NHCAA under which they will
co-operate in areas such cross border fraud and share information
and expertise.
“This memorandum is an important milestone for us” said Ray
Collins, chairman of the HICFG.
“It will offer unparalleled opportunities for us to share problems
with and to learn from our colleagues in the US who are undoubtedly
the world leaders in this field.”
Established in 1985, the NHCAA is the only national organisation in
the US devoted exclusively to combating health care fraud.
Its members comprise most of the prominent US private health
insurers, federal, state and local government law enforcement
agencies and regulatory agencies.
The HICFG is an industry initiative with its membership consisting
of health insurance companies.
The organisation is supported by the Association of British
Insurers and participation by non-member attendees includes the
National Health Service’s (NHS) counter fraud unit and the City of
London Police.
The NHS’ counter fraud unit and the HICFG already have a
co-operation agreement in place with further links being developed
with health insurance industry players in Australia, South Africa,
Canada and in Europe.
According to the HICFG, typical health care fraud brokers falsify
insurance applications to gain commission, customers provide false
information about treatment and dishonest doctors exaggerate
treatment or charge for services not actually provided.
