Take a people-are-opportunities view of anti-fraud training

Does your company have a strategic plan in place for anti-fraud training and communications? It's an idea worth considering. Because when it comes to detecting health insurance fraud, waste and abuse, people are opportunities.

If we accept that a small subset of the provider and customer base commits fraud, it follows that most health insurance stakeholders are honest. Compelling calls to action can rouse them to help tackle a problem that threatens the healthcare system.

But too often we compartmentalize training and communications. Payers release an annual e-training, for example, or add a special investigations page to corporate websites. These efforts are helpful but isolated; they're like crossing a requirement off a to-do list.

Besides typical training sessions, why not weave anti-fraud communications into everyday business? This involves delivering messages in new ways. Sharing stories about fraud schemes, criminal prosecutions or recovered money can contribute to an SIU's visibility and success, as FierceHealthPayer: Anti-Fraud reported.

Look at both ends of the employment spectrum. Do new employees receive anti-fraud orientation? Do terminated staff have a chance to report suspected fraud at exit interviews?

Kellyann Bowman, SIU manager at Group Health Cooperative in Seattle, discussed the importance of wide-ripple outreach in an exclusive interview with FierceHealthPayer: Anti-Fraud. "What makes us effective are partnerships with departments and work units across the organization," Bowman said. "Educate coworkers on what healthcare fraud is. ... Be sure they understand how the SIU protects healthcare dollars. Once people see they can function as part of the SIU by identifying potential fraud, you can get their buy-in since they become part of a larger process."

In keeping with this advice, does your company spot train areas that may encounter fraud? Think of claims processing, sales or provider and customer call centers. Why not make targeted anti-fraud presentations at their team meetings?

You don't need a lot of time for this; long trainings can put people to sleep. Distill your message into three key points you want staff to remember, and deliver these in short, frequent bursts.

Using in-house communication vehicles in new ways can be helpful. Can you refresh anti-fraud messaging on the corporate intranet through a front page banner promoting the hotline? Can you do a short commercial for the SIU at an all-employee meeting? Are there other events the SIU could speak at or sponsor?

"The more people recognize the face of the SIU in your company," Bowman said, "the more likely it is that they'll talk to you about issues. That's where you'll get good leads." Bowman also job shadows staff who fill newly created roles to see how fraud may present itself in their work.

Then examine how external customers receive anti-fraud messages. When investigators do on-site audits at provider offices, for example, WellPoint Investigations Director Alanna Lavelle recommended passing out business cards to provider employees to cultivate witnesses.

Another possibility is sharing tips with providers on how to guard against fraud-related shenanigans by corrupt staff. Some providers deny responsibility for fraud and abuse by blaming their long-suffering secretaries for it; but sometimes bad actors in the office are culpable as in the case of the pilfered prescription pads belonging to Carmen Ortiz-Butcher, M.D.

Another tactic is helping provider employees recognize and report telltale signs of medical identity theft.

Finally, think about improving member education. How often can you publicize what fraud is, what it costs and how to report it?

"Look at the banking and finance industries for lessons learned," identity theft expert Ann Patterson advised in an exclusive interview with FierceHealthPayer: Anti-Fraud. "If you go to a bank, the messaging about fraud is pervasive. You may see a poster at your branch office with information about protecting yourself online. When was the last time you saw that when you went to your doctor's office or a hospital or when you filed something with your insurance company?" Patterson said.

Training is a key piece of anti-fraud strategy. For the message to stick, we need to think beyond one-and-done annual events. Consider piling up training moments for stakeholders all year. Give them reasons to care about fraud. This can turn those you serve into satellite staff.

People are anti-fraud opportunities. Have you maximized yours? - Jane (@HealthPayer)