Law Enforcement Resources
Creating opportunities for Member Organizations and Law Enforcement to share health care anti-fraud information is fundamental to NHCAA's Mission. NHCAA enables information-sharing using a number of approaches:
SIRIS (Special Investigation Resource and Intelligence System)
Information-Sharing Guidelines/Meetings
Case-Specific Requests for Investigation Assistance (RIAs)
Peer Experience Resource Center (PERC)
Fraud Alerts
SIRIS (SPECIAL INVESTIGATION RESOURCE AND INTELLIGENCE SYSTEM)
Powered by LexisNexis, SIRIS is the cornerstone of NHCAA’s information-sharing activities, allowing users to effectively communicate critical information about potential fraudulent activity using Web-based advanced information technology. SIRIS is a cutting-edge searchable database that consists of two data sets: one devoted to provider investigations; the other to health care fraud schemes. The strength of SIRIS is dependent on the reciprocal sharing of information among our many members, both private and public. Participating organizations are given significant capabilities to manage their activity in SIRIS, including generating detailed activity reports. Training sessions are provided for users and administrators. To access SIRIS, click here.
INFORMATION-SHARING GUIDELINES
To take part in NHCAA information-sharing activities, participating organizations must have a signed NHCAA Information-Sharing Agreement on file at NHCAA headquarters.
NHCAA encourages that, from time to time, SIU managers and investigative personnel review the NHCAA Guidelines Governing Participation of NHCAA Organizations in NHCAA Anti-Fraud Information-Sharing Activities which specifically state that "All information received from or through NHCAA should be distributed within participating organizations only on a need-to-know basis. This information, to the extent possible, should be kept within anti-fraud units." (Emphasis added.) The Guidelines are available online upon accessing NHCAA's Special Investigation Resource and Intelligence System (SIRIS) database.
Organizations permitted to participate in NHCAA Information-Sharing Activities are those NHCAA Member Organizations or Affiliate Members that have current signed Information-Sharing Agreements on file with NHCAA. Certainly, members of NHCAA may share their own data with others if they wish.
In-Person Information-Sharing Meetings
NHCAA hosts information-sharing meetings throughout the year, which are held in conjunction with NHCAA Membership Forum meetings. Member Organizations meet directly with their peers to examine and discuss noteworthy cases as well as to share information and have in-depth discussions about new and emerging fraud schemes. In addition, time is devoted to exploring and discussing management issues of interest to SIU leaders. There is simply no substitute for the opportunity to meet face-to-face with colleagues to share investigative insight. Egregious and far-reaching health care fraud schemes have been identified during these meetings.
CASE-SPECIFIC REQUESTS FOR INVESTIGATION ASSISTANCE (RIAs) FROM LAW ENFORCEMENT
This unique tool in the war against health care fraud allows prosecutors and law enforcement agencies to submit inquiries concerning specific cases of suspected health care fraud for distribution to NHCAA Member Organizations. Exemplifying the value of NHCAA’s private-public partnership, the RIA process is quick and efficient, assisting in case development and in identifying additional victims of fraud.
The RIA process provides Law Enforcement Liaison Members the ability to reach scores of private health insurers in one simple step for assistance in their health care fraud investigations. The identification of additional fraud victims and the ability to increase the dollars lost to fraud are important elements in the investigation process. NHCAA private-sector Member Organizations are encouraged to respond to RIA requests as quickly as possible. Upon receipt, the requests should not be copied or distributed outside of the investigations component of your organization, information included in the RIAs should not be disclosed, and no independent action should be undertaken.
PEER EXPERIENCE RESOURCE CENTER (PERC)
The collective fraud fighting experience of our Member Organizations is invaluable. The Peer Experience Resource Center (PERC) offers members the chance to seek input from their industry peers about unusual, pressing or particularly challenging investigations or policy-related issues. PERC offers the ability to reach out to NHCAA's membership quickly and effectively.
Member Organizations can take advantage of PERC to solicit information from Membership Forum representatives and Law Enforcement Liaisons about a broad range of management issues or concerns as well as recommendations involving complex investigations. Many NHCAA members have utilized the process and have benefited from the peer information received. As with all NHCAA information-sharing activities, PERC is dependent on mutual participation among our members.
PERC requests can be submitted to NHCAA through your designated NHCAA Member Organization representative by contacting Michael J. Costello, NHCAA Director of Investigation Support, at mcostello@nhcaa.org.
FRAUD ALERTS
Members receive periodic email alerts notifying them of important and timely developments affecting the health care fraud fighting field as well as potential and emerging fraud threats and schemes.
NOTE: NHCAA Information-Sharing Activities are coordinated by Michael J. Costello, NHCAA Director of Investigation Support. Mike can be contacted at mcostello@nhcaa.org.