The Centers for Medicare & Medicaid Services (CMS) has posted to the Federal Register's Public Inspection Desk a final rule implementing Medical Loss Ratio (MLR) Requirements for Medicare Advantage and Medicare Prescription Drug Benefit Programs (Medicare Parts C & D).

The U.S. Department of Health and Human Services, Office of Inspector General today issued a final rule relating to the use of data mining by Medicaid Fraud Control Units (MFCUs).

The collective fraud fighting experience of our Member Organizations is an invaluable resource. PERC (Peer Experience Resource Center) offers NHCAA Membership Forum Representatives 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 NHCAA's membership quickly and effectively.

NHCAA is pleased to announce that the Request for Investigation Assistance (RIA) process has been integrated into the Special Investigation Resource and Intelligence System (SIRIS) secure database - NHCAA's premier information-sharing and fraud fighting tool. The RIA process is a unique members-only tool that allows our Law Enforcement Liaisons to submit inquiries concerning specific cases of suspected health care fraud for distribution to NHCAA Member Organizations.

NHCAA In the News, 2012

Working on an interesting case? Uncover an emerging scheme? Share an abstract to present at NHCAA's 2013 Annual Training Conference, November 18-21 in Orlando, Florida. Deadline for submission is March 20.

Senators issue report compiling ideas from 160+ organizations (including NHCAA) on preventing and combating health care fraud, waste and abuse.

The Fiscal Year 2012 Health Care Fraud and Abuse Control (HCFAC) Program Report to Congress was recently published. The national Health Care Fraud and Abuse Control Program (HCFAC) was established under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The Program is carried out jointly at the direction of the Attorney General and the Secretary of the Department of Health and Human Services (HHS), acting through the Inspector General.

Last year proved to be one of enormous success for NHCAA, confirming once again that the Association provides our members, partners, and the industry as a whole with a range of effective resources to improve and strengthen the fight against health care fraud.

NHCAA announces the addition of a new member resource to the website. The NHCAA Anti-Fraud Laws Database offers state-by-state profiles that include legal citations along with the accompanying statutory and regulatory language.

Resources have been developed to help providers understand the law and the consequences for ignoring health care fraud. Learn how to develop a culture of compliance and where and when to report fraudulent behavior.

Fake insurance scams are abundant. Beware of too good to be true coverage and rates, and don't provide personal information without first investigating the legitimacy of the company.

The United States spends over $2.7 trillion on health care every year. Of that amount, NHCAA estimates that tens of billions of dollars are lost to health care fraud.

Don't throw away the Explanation of Benefits (EOB) you receive from your insurer; it could contain important clues to uncover health care fraud.

Treat your health insurance card like your credit card. Medical identity theft is a fast-growing crime, and difficult to rectify. Medical identify theft occurs when someone steals your insurance card number to obtain prescriptions, medical services or medical supplies.

The Senior Medicare Patrol (SMP) is a grassroots network of volunteers who work to educate seniors and other Medicare and Medicaid beneficiaries on how to protect, detect, and report health care fraud.

If offered a complimentary medical service, beware! Offers of "free" medical treatments or consultations often sound appealing and legitimate. They may come in advertising, a telephone solicitation, or even at your front door.

This Web page contains information about OIG's most wanted health care fugitives. In all, the HHS-OIG is seeking more than 170 fugitives on charges related to health care fraud and abuse. Here are some of the faces of health care fraudsters.

In South Florida alone, government programs and private insurers have lost hundreds of millions of dollars in recent years to criminal rings that fabricate claims from non-existent clinics, using genuine patient-insurance and provider-billing information that the perpetrators have bought and/or stolen for that purpose.

Although the precise method may vary, the scheme generally involves someone pretending to be from the Government, a diabetes association, or even Medicare, calling you to offer "free" diabetic supplies, such as glucose meters, diabetic test strips, or lancets.

NHCAA CEO Louis Saccoccio testified before the Health Subcommittee of the House Committee on Energy and Commerce November 28, 2012. The hearing, entitled "Examining Options to Combat Health Care Waste, Fraud and Abuse" focused on a number of issues related to fraud in our current health care system, in particular, Medicare fraud.

(Anaheim, CA) - The National Health Care Anti-Fraud Association (NHCAA) today presented its Investigation of the Year Award to the consortium of federal and state agencies who uncovered a major health care fraud scheme committed by a convicted Texas psychiatrist, Anthony Francis Valdez, who wrongly billed over $42 million in medical procedures, received payments totaling over $12 million in office visits not performed, and employed unqualified individuals, including a janitor, to administer p...

(Anaheim, CA) -The National Health Care Anti-Fraud Association (NHCAA) awarded its 2012 Medical Director Award to George M. Koumaras, DDS for his outstanding accomplishments in the health care fraud- fighting field.

(Anaheim, CA) - The National Health Care Anti-Fraud Association (NHCAA) today announced that Alanna M. Lavelle, AHFI, MS, CPC, Director of Special Investigations of WellPoint, Inc., has been elected as the new Chair of the Board of Directors. Lavelle succeeds Jack Price, former Chief Security Officer of BlueCross BlueShield of Tennessee.

Hear OIG's top leadership discuss issues such as improper payments, Medicare fraud, exclusions, and other key subject areas from the recently published 2013 Work Plan.

Health care fraud is a serious crime that can affect anyone. If you have observed or been a victim of health care fraud, learn about the resources available and ways to report it.

In a February 8, 2012 notice, CMS solicited public comments on the draft version of the Compliance Program Guidelines. NHCAA along with 67 other entities submitted comments. Upon review, CMS incorporated a number of the recommendations made by NHCAA into the final guidance.

The majority of health care fraud is committed by organized crime groups and a very small minority of dishonest health care providers. The most common types of health care fraud include:

Make sure to budget adequate travel dollars for training and travel to take advantage of NHCAA's educational programs. Member Organizations and Law Enforcement Liaisons receive up to two tuition-free seats per individual NETS program, Platinum Supporting Members receive one.

The National Health Care Anti-Fraud Association (NHCAA) Chief Executive Officer Louis Saccoccio released the following statement regarding the U.S. Department of Health and Human Services (HHS) announcement awarding $9 million to the Centers for Medicare & Medicaid Services (CMS) to help Senior Medicare Patrol (SMP) programs across the nation continue their work fighting Medicare fraud.

Blue Cross and Blue Shield of Georgia Wins the NHCAA Investigative Excellence Award for its investigation of Wellness One, for suspicious billing patterns which resulted in millions of dollars of fraudulent claims.

Dr. Yao serves as Senior Medical Director of Medical & Payment Policy with Blue Shield of California and chairs Blue Shield of California's Pharmacy & Therapeutics Committee.

Jack L. Price, AHFI, ALHC, CFE, Chief Security Officer of BlueCross BlueShield of Tennessee (BCBST), has been elected as the new Chair of the NHCAA Board of Directors.

The National Health Care Anti-Fraud Association (NHCAA) Chief Executive Officer Louis Saccoccio released a statement today regarding the White House announcement of the new National Fraud Prevention Partnership.