Priority Health is reducing health care costs by eliminating fraud and abuse
(Grand Rapids, Mich. - April 25, 2011)
Priority Health is working to reduce health care costs for its members by eliminating fraud and abuse in the system. Industry research projects fraud and abuse accounts for as much as 10% of the total medical spend in the U.S. health care system.
"Everyone in the health care industry has a responsibility to stop abuse in the system," said Kimberly K. Horn, president and CEO of Priority Health. "By stopping these practices before they happen, we can do our part to keep health care affordable and accessible to all people."
In 2009, a Thomson Reuters analysis estimated the total avoidable health care costs in the U.S. is $700 billion annually. Of that amount, 19% or $133 billion is attributed to the cost of fraud.
Priority Health educates members and providers on how to identify fraud and abuse via regular communications and its website. Anyone can report suspicious practices to the company for investigation with certainty of confidentiality.
The key difference between fraud and abuse is intent. Examples of fraud include intentionally misrepresenting a diagnosis to justify higher payment or stealing membership information to bill for services not performed. Abuse includes the practice of unintentionally using incorrect coding.
Health care fraud impacts every aspect of the industry. Health care fraud drives up the cost of premiums which impacts employers' bottom line. For providers, individuals without insurance are putting more pressure on an overburdened system.
The Priority Health Fraud & Abuse department is targeting specific practices in an effort to recover funds and end fraudulent practices. Among these are identifying claims which have been incorrectly unbundled, tracking claims for controlled substances to discover abuse and auditing claims to identify duplicate claims and coding errors.
Learn how to notify the company of suspected fraud or abuse in the fraud and abuse section of this website.
About Priority Health:
Priority Health is an award-winning health plan nationally recognized for creating innovative solutions that impact health care costs while maximizing customer experience. It offers a broad portfolio of products for employer groups and individuals including Medicare and Medicaid beneficiaries. As a nonprofit company, Priority Health serves more than 600,000 people and continues to be rated among the best health plans in the nation by the National Committee for Quality Assurance.
