Horizon fought fraud to the tune of $45.4M in savings in 2014

New Jersey Horizon Blue Cross Blue Shield said on Tuesday that 2014 fraud prevention action saved $ 45.4 million, including recovered funds and losses avoided by the early detection of malware. According to the company, this is the best recovery / prevention since the special investigation department was established in Horizo ​​in 1983.

Douglas Falduto, executive vice president of management, says: The person in charge said. Horizo ​​'s security guard "With leading - edge software and intelligent detective work, we continue to improve the ability to identify and investigate suspicious claims and bring them closer to real time claims."

Horizon said in 2014 that SIU opened 1,318 new cases suspected of suspicious fraud, and many investigators initially warned their fraud prevention hotline. (800) 624-2048. Horizon said the hotline received 2,450 calls in 2014

According to the company, there is a possibility that health care providers and consumers are involved in fraud and abuse. A common example is as follows.

"Horizon is committed to ensuring that members' medical expenses are appropriately used.Employees, healthcare workers, and members should pay attention to suspicious activities and claims and report to the SIU. I will recommend it, "Falduto says.

Health care fraud prevention association estimates that annual health care fraud loss is tens of billions of dollars

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 special team of experts - Horizon BCBSNJ's Special Investigation Bureau (SIU) - generated $ 43.2 million savings, identified as a combination of collection fund and loss avoidance, and 988 new fraud cases occurred.

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.