SYS-CON MEDIA Authors: Sean Houghton, Glenn Rossman, Ignacio M. Llorente, Xenia von Wedel, Peter Silva

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Blue Cross Blue Shield of Michigan’s New Advanced Analytics Anti-Fraud Solutions to Be Featured at National Conference

Fraud, waste and abuse cost health plans and their members up to $270 billion annually. As those committing fraud become more sophisticated, health plans need equal sophistication to see relevant patterns in a growing sea of data. To fight improper payments more effectively, Blue Cross Blue Shield of Michigan uses SAS® Fraud Framework for Health Care, from SAS, a leader in health analytics software and services.

“With this technology we will be able to investigate unusual payment patterns much earlier in the cycle and interrupt the activity,” said Greg W. Anderson, vice president of Corporate and Financial Investigations for BCBSM. “If we discover improper billing once claims are paid, the recovery of funds is much more difficult. By using predictive analytics to detect aberrant activity early on, we can reduce our losses and increase recoveries.”

Doug Cedras, BCBSM director of Corporate and Financial Investigations, and Julie Malida, SAS principal for Health Care Fraud Solutions, will be discussing the Blues’ use of advanced analytics to fight health care fraud and root out improper payments at the National Health Care Anti-Fraud Association (NHCAA)’s Annual Training Conference (ATC). The ATC is recognized industry-wide one of the nation’s leading health care anti-fraud forums. The session takes place in Orlando, Fla. on Tuesday, November 19 from 3:10-4:10 p.m.

“Being able to identify fraud, waste, and abuse early and quickly is key to bringing people who commit health care fraud to justice,” says Anderson. “We are excited to work with SAS® advanced analytics and proud to have our anti-fraud solutions recognized as best practice.”

Blue Cross Blue Shield of Michigan became the first insurer in the U.S. to launch its own health care fraud investigations unit in July 1980. The Blues’ fraud investigation unit coordinates investigations with the FBI, the Office of Inspector General for the U.S. Department of Health and Human Services, Michigan State Police and local police departments. It also assists with state and federal prosecutions. Since 1980, BCBSM’s Corporate and Financial Investigations unit has recovered more than $325 million. If you have concerns about potential health care fraud, please contact the BCBSM toll free Anti-Fraud Hotline at 1-800-482-3787.

Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. For more information, visit www.bcbsm.com/news and www.mibluesperspectives.com.

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