Medical Mutual of Ohio Reports Record High Fraud Recovery

Health insurer reclaims $8.1 Million in healthcare fraud in 2010

CLEVELAND, Jan. 11, 2011 /PRNewswire/ -- A highly focused team of professional healthcare fraud investigators using highly sophisticated software helped Medical Mutual of Ohio reclaim an all-time high of $8.1 million of fraudulent activity in 2010.

"What it all comes down to is criminals picking the pockets of our health insurance customers and in the end, the cost of fraud is passed on to all of us," said Brien Shanahan, Medical Mutual's director of Legal Affairs.

Shanahan explained that the key to his fraud investigation team's financial recovery in 2010 is two-fold. "It is a combination of a group of talented investigators with diverse and complementary skills working as a team with modern-day technology. Our software identifies and flags questionable claims activity, which gives our investigators a big jump in nabbing healthcare criminals."   Shanahan added that Medical Mutual fraud investigators have reclaimed more than $44 million in fraudulent claims for the company since 2003.

Honored nationally by the National Health Care Anti-Fraud Association (NHCAA) in Washington D.C., Medical Mutual's financial investigation team probes an estimated 125 cases of potential healthcare fraud per year and has produced more than 750 indictments since its inception in 1983.

NHCAA Executive Director Louis Saccoccio said the dedication of the award-winning Medical Mutual team is remarkable. "At a  time when every healthcare dollar matters, these investigators never blink. They are doing a great job in nabbing the health insurance fraud artists who make medical costs higher for all of us."

According to Saccoccio, the NHCAA conservatively estimates $68 billion is lost to healthcare fraud each year, which translates into higher premiums and out-of-pocket expenses for consumers.

Founded in 1934, Medical Mutual of Ohio is  the oldest and largest health insurance company based in Ohio. For more than 75 years the company has served its customers through high-quality, affordable group and personal health insurance plans, and third- party administrative services to self-insured group customers. For more information, visit the company's award-winning Web site at

The National Health Care Anti-Fraud Association (NHCAA) – Established in 1985 by several private health insurers and federal and state government officials, NHCAA is the only national U.S. organization devoted exclusively to combating health care fraud. NHCAA's mission is to protect and serve the public interest by raising awareness and improving the detection, investigation, prosecution and prevention of health care fraud. Since its founding, NHCAA has remained a private-public partnership with its members comprising the nation's most prominent private health insurers as well as those Federal, state and local government law enforcement and regulatory agencies having jurisdiction over health care fraud.

SOURCE Medical Mutual of Ohio