News in brief - Sept. 5, 2005

Blues details fraud recoveries - Tenet settles uninsured billing case - N.J. plan offers Internet access - HIP makes consumer-directed move

Blues details fraud recoveries

The BlueCross BlueShield Assn. says its member plans in 2004 saved or recovered a collective $228 million through the company's anti-fraud efforts.

The Blues, in an Aug. 22 news release, claimed its investigative units recovered $120 million in fraudulent claims, and prevented the payout of another $108 million in fraudulent claims.

All total, 663 cases last year were referred to law enforcement authorities, representing an increase of 14.7% over 2003, the Blues said. In those cases, 189 warrants and indictments were issued, an increase of nearly 17%.

Hotline calls received by Blues plans increased by more than 15%, to more than 80,000 calls, according to the Blues.

Tenet settles uninsured billing case

Tenet Healthcare Corp. is a step closer to resolving scores of lawsuits brought by uninsured patients who claim they were overbilled for care at 114 hospitals owned by the Dallas-based company.

Judge Wendell Mortimer Jr. of Los Angeles County U.S. Superior Court on Aug. 8 approved a proposed settlement in which Tenet agreed to issue some refunds and offer uninsured patients the same discounts available to managed care participants for at least four years, according to a law firm representing the plaintiffs, Hagens, Berman, Sobol, Shapiro, LLP.

Tenet spokesman Steve Campanini said the judge's approval would affect litigants in California.

Those involved in similar class-action lawsuits in eight other states would have to decide whether to accept the settlement or appeal the decision, he said. Those states are Alabama, Florida, Louisiana, Missouri, Pennsylvania, South Carolina, Tennessee and Texas.

Tenet, which did not admit any wrongdoing under the settlement, previously said that it had set aside $30 million to resolve the claims.

N.J. plan offers Internet access

Horizon Blue Cross Blue Shield of New Jersey announced Aug. 12 that it will offer two years of free high-speed Internet access to physicians who lack such a connection.

The offer is part of Horizon's $5 million Health Connections initiative to increase the number of doctors using a service enabling them to electronically verify patient insurance eligibility, co-payment and benefits, check status of claims and authorizations, submit referrals, and review medical policies and drug formularies.

HIP makes consumer-directed move

HIP Health Plan of New York announced that it has acquired PerfectHealth Insurance Co., which sells high-deductible health insurance policies in the New York area. Completion of the transaction is subject to regulatory approval.

HIP, which has 1.4 million members, said the purchase was related to its recent launch of its first consumer-directed health plan, myFund. The purchase of PerfectHealth, HIP said, expands its interest in consumer-directed health care, particularly through health savings account and health reimbursement account offerings.