January 02, 2012

CLEVELAND - In 2011, the one-two, fraud-fighting punch of skilled investigators and highly advanced software helped Medical Mutual reclaim an all-time high of $9.78 million in fraudulent medical claims and billing activity.

The company’s 2011 recovery outpaces the 2010 mark by more than $1.5M.

The record recovery raises some noteworthy discussions in the healthcare industry. Could it be that healthcare fraud is more rampant – or could it be that Medical Mutual’s fraud-fighting team is world-class in its proficiency? “Definitely both,” explained Brien Shanahan, Medical Mutual’s director of Legal Affairs. “Our software first flags questionable claims activity and our awardwinning financial investigation team moves in, takes a closer look and then gets the drop on these criminals who are literally picking the pockets of healthcare consumers,” said Shanahan.

“The year 2011 was one of our busiest years in the near 30 year history of our financial investigation unit,” Shanahan added. “We investigated nearly 160 fraud cases and assisted in two federal indictments.”

The Transactional Access Records Clearinghouse, a national non-profit group that uses government documents to track healthcare fraud data illustrates the crime’s wildfire pace. The Clearinghouse’s statistics show the nation is on track for an 85 percent increase in healthcare fraud prosecutions over 2010 when records were last available.

Shanahan said Medical Mutual’s financial investigation team probes an estimated nearly 150 cases of potential healthcare fraud per year and has produced nearly 800 indictments since its inception in 1983. The team has been honored nationally by the National Health Care Anti-Fraud Association (NHCAA) in Washington D.C.

NHCAA Executive Director Louis Saccoccio had high-praise for the award-winning Medical Mutual team. “Their investigators never blink. They’re doing a great job in nabbing the health insurance fraud artists who make medical costs higher for all of us.” Saccoccio conservatively estimates that upwards of $70Billion is lost to healthcare fraud each year, which translates into  higher premiums and out-of-pocket expenses for consumers.


About Medical Mutual: Founded in 1934 Medical Mutual of Ohio is the oldest and largest health insurance company based in Ohio. For more than 75 years the company has served its customers through highquality, affordable group and personal health insurance plans, and third-party administrative services to self-insured group customers. For more information, visit the company’s awardwinning Web site at MedMutual.com.

About The National Health Care Anti-Fraud Association (NHCAA): Established in 1985 by several private health insurers and federal and state government officials, NHCAA is the only national U.S. organization devoted exclusively to combating health care fraud. NHCAA’s mission is to protect and serve the public interest by raising awareness and improving the detection, investigation, prosecution and prevention of health care fraud. Since its founding, NHCAA has remained a private-public partnership with its members comprising the nation’s most prominent private health insurers as well as those Federal, state and local government law enforcement and regulatory agencies having jurisdiction over health care fraud. NHCAA.org.