NHCAA distributed the Association's 2018 Year-in-Review highlighting the past year's successes and accomplishments, confirming once again that the Association provides our members, partners, and the industry with a range of effective resources to improve and strengthen the fight against health care fraud.

The National Health Care Anti-Fraud Association (NHCAA) announced that Roger I. Purnell, AHFI, CFE, Director of the Special Investigations Unit (SIU) at BlueCross BlueShield of North Carolina (BCBSNC) has been elected as the 2019 Chair of the NHCAA Board of Directors.

NHCAA would like to congratulate the winners of the 2018 NHCAA Awards Program: Investigation of the Year, Medical Directors, John Morris Volunteer Service and SIRIS Investigation of the Year.

NHCAA recently published its biennial benchmarking survey, the Anti-Fraud Management Survey for Calendar Year 2017. The full Survey Report is accessible only to Member Organizations and Law Enforcement Liaisons.

NHCAA has published a new white paper that examines the scope of responsibility of health insurer special investigations units and how they calculate return on investment within their organizations. NHCAA’s biennial Anti-Fraud Management Survey reports on SIU outcomes, which have historically been combined to calculate SIU return on investment. This new paper provides insight about the challenges in measuring SIU ROI while demonstrating the value SIUs bring to their organizations.

The Centers for Medicare and Medicaid Services (CMS) has proposed significant changes to how medical loss ratio is calculated and reported for Medicare Advantage and Part D plans. If made final, the rule would expand the definition of Quality Improvement Activities (QIA) to include fraud reduction activities, including fraud prevention, fraud detection, and fraud recovery. NHCAA submitted a letter of support.