NHCAA survey results provide a benchmark for SIUs

The National Health Care Anti-Fraud Association released results of its latest anti-fraud management survey, a tool to help payers compare the structure, staffing, funding, operations and results of their anti-fraud efforts to those of similar companies and the industry as a whole.     

"The NHCAA Survey is the most comprehensive healthcare fraud survey available and demonstrates the commitment insurers have made to protect their members from those who cheat the system and facilitate patient harm," Darrell S. Langlois, vice president of compliance, privacy and fraud at Blue Cross Blue Shield of Louisiana and NHCAA board member, told FierceHealthPayer: Anti-Fraud in an email. 

The 2013 survey report is based on data from 52 private insurers. Respondents offer products including medical, dental, disability, health savings accounts, long-term care, pharmacy, vision and workers' compensation, according to the NHCAA's executive summary.

Survey results show the organizational value of anti-fraud efforts. Respondents reported special investigations unit (SIU) outcomes in categories including recoveries, savings and prevented loss. "The fraud-fighting teams that comprise the 2013 survey base recover and save their companies money at a rate that outpaces the average SIU's operating budget by 10.2 to one," the summary noted.   

The annual operating budget of an SIU averages more than $2.66 million, but this varies with business volume and numbers of covered lives. And the median size of respondents' SIUs was 10.5 full-time equivalents.   

"This year's suvery sheds light on the efficiency--but also the stamina--of insurer special investigations units," Langlois observed. On average, SIUs closed 769 fraud investigations in 2013. Fifty percent of these were closed within 60 days, but nearly a third of closed cases required more than nine months of work. 

Finally, participants reported that SIU employees complete an average of 30 hours of training annually. And more than three-quarters of respondents reported using data analytics to fight fraud. "Various types of analytics are now in play and we will likely continue to see new analytic tools and tactics in the coming years," Langlois commented.  

For more:
- here's access to the executive summary. The full report is available exclusively to NHCAA members.  

 

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