The fight against health care fraud

Health care fraud is theft by deception, and a significant concern of Highmark and the entire health insurance industry. According to National Health Care Anti-Fraud Association estimates, 3 to 5 percent of what Americans spend annually on health care — between $30 billion and $50 billion a year — is lost to fraud.

At Highmark, we take a proactive approach to detecting and investigating potential health care fraud and abuse. This includes taking action to deal with fraudulent activity against the company.

SIU aggressively investigates potential fraud

The role of Highmark's Special Investigations Unit (SIU) is to detect and investigate alleged fraud in all lines of Highmark business, except where Highmark serves as a federal contractor for the FMDP, Medicare Part A and Medicare Part B coverages.

SIU’s aggressive approach to the investigation of potential health care insurance fraud cases is reflected in its mission statement:

• Maintain the integrity of Highmark Inc., its subsidiaries, affiliates and employees through the proactive detection, investigation and pursuit of potential fraud and abuse.
• When necessary, take internal and/or external action that will ultimately enable Highmark Inc. to provide quality, affordable health care insurance to all its clients.

Highmark strives to protect health care dollars that otherwise might be lost or wasted. Highmark's SIU consistently works with members and providers to address issues and concerns.

* A referral is any internal or external inquiry alleging potential fraud and abuse involving health care received in Highmark's Special Investigations Unit.

** Includes referrals to regulatory agencies.