Horizon BCBSNJ investigators ferret out fraud

A few offenders often hide medical fraud, but members of Horizon Blue Cross Blue Shield and New Jersey employers are losing millions of dollars each year.

Therefore, Horizon BCBSNJ continues to invest in state-of-the-art inspection technology and invests in sharp team researchers to protect the integrity of New Jersey's healthcare service system. In 2015, this special team, Horizon BCBSNJ's special research division, produced a saving of $ 43,880,000. It was collected in 988 cases and decided to be avoided.

Douglas Falduto, executive vice president and chief security officer at Horizon BCBSNJ, says: I said at a press conference. "SIU focuses on fraud prevention with intelligent detection capabilities that isolate suspicious patterns and anomalies of enhanced analysis tools and claims."

Fraud and abuse can involve health care providers and medical consumers. A common example is as follows.

Horizo ​​n BCBSNJ will use its collected skills and other information to conduct its own investigations and filing lawsuits with law enforcement agencies for criminal prosecution. In 2015, Horizon BCBNSNJ filed 187 lawsuits against insurance fraud prosecutors in New Jersey State, Attorney's Office in New Jersey, Federal Bureau of Investigation and other institutions. Horizo ​​n Blue Cross Blue Shield, the oldest and largest health insurance company in New Jersey, is a non-profit health service company paying taxes that offers a variety of medical, dental and prescription insurance products and services I will. Through collaboration with doctors and hospitals, Horizo ​​n BCBSNJ leads innovation in health care in New Jersey and offers an innovative, patient-centered program that rewards high-quality medical treatment, not the amount that patients receive It offers. For more information, please visit http://www.HorizonBlue.com.

While a few offenders often hide health care fraud, members of Horizon Blue Cross Blue Shield in New Jersey and employers lose millions of dollars each year. Therefore, Horizon BCBSNJ continues to invest in state-of-the-art inspection technology and invests in sharp team researchers to protect the integrity of New Jersey's healthcare service system. In 2015, the expert team - Horizon BCBSNJ's Special Investigation Bureau (SIU) - generated $ 43.2 million in savings, was identified as a combination of collection funds and loss avoidance, opened 988 new fraud cases

Douglas Falduto, executive vice president and chief security officer at Horizon BCBSNJ, says: I said at a press conference. "SIU focuses on fraud prevention with intelligent detection capabilities that isolate suspicious patterns and anomalies of enhanced analysis tools and claims."