Blues plan revamps program after $300K fraud

Blue Cross Blue Shield of Kansas City limits annual rewards, vertifies outcomes

Members of Blue Cross Blue Shield of Kansas City's wellness program committed fraud by falsely claiming to have participated in certain activities to receive financial rewards. But the insurer says it has revamped its program so it can continue offering health and wellness incentives.

The wellness program, which Blue Cross launched in 2010, is based on a point system, providing financial rewards of up to $250 when members and/or their dependents receive points for partaking in a set of healthy activities, Workforce Management reported.

However, seven Blue Cross members, employed by Kansas City or Jackson County, were arrested for allegedly stealing $300,000 from the insurer. The members falsified records to show they completed strenuous activities, which reward more points and therefore more money, the Kansas City Business Journal reported. Some even claimed their young children completed duathlons, marathons and triathlons to earn extra money.

After learning of this healthcare fraud scheme, Blue Cross has redesigned its wellness program so that the results can be more easily verified, the Kansas City Star reported.

For example, it prohibits self-reporting and is now focused on "outcomes and verifiable activities," including getting blood pressure checked, completing a survey on lifestyle and participating in educational seminars and engaging with a nurse or a coach, Gregg Laiben, Blue Cross medical director, recently told the city council. Blue Cross also reduced the maximum reward allowed for any year to only $100.

To learn more:
- read the Workforce Management article
- see the Kansas City Business Journal article
- check out the Kansas City Star article

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