Blue Cross & Blue Shield United of Wisconsin is taking on Medicare fraud with a new computerized detection system. The Fraud and Abuse Management System (FAMS) allows the insurance giant to identify patterns of fraudulent behavior that may occur among healthcare providers.
As one of the nation's largest processor of home health claims for the Medicare program, the insurer annually processes more than 8 million Medicare claims nationwide.
The FAMS system works in tandem with the Medicare Fraud and Abuse Department's United Government Services fraud-fighting team. The system allows Blue Cross to compare healthcare providers' behavior with their peers using billing data and rankings.
And, Blue Cross of Wisconsin has also taken its anti-fraud stance online for consumers to become aware of its fraud-fighting efforts. Because of the vast volume of Medicare claims handled by Blue Cross, the company worked closely with IBM to enhance the FAMS system at an approximate annual cost of $435,000.
The online system, HealthNet Connection (http://www.healthnetconnect.net), explains the types of healthcare fraud and answers frequently asked questions about the problem. A special area helps consumers report fraud directly to the U.S. Attorney's Office. (Blue Cross Corp. Comms., 414/226-5756)