Monday, January 23, 2023
Highmark’s Financial Investigations and Provider Review (FIPR) Department is a recognized industry leader in healthcare anti-fraud, waste and abuse programs and related outcomes
Charleston, W.Va. (January 23, 2023)—A collaborative effort between Highmark West Virginia, Highmark’s Financial Investigations and Provider Review (FIPR) department, the Federal Bureau of Investigation (FBI) and the West Virginia Department of Education has earned a 2022 Excellence in Public Awareness honor from the National Health Care Anti-Fraud Association (NHCAA) for its community-wide initiative to educate West Virginia middle-school and high school-aged youth on the dangers of opioid use.
“Our FIPR team is dedicated to protecting our customers and their health care dollars by identifying, preventing and stopping activity related to health care fraud, waste and abuse,” says Kurt Spear, vice president of FIPR for Highmark. “Efforts to truly make an impact on health care fraud, waste, and abuse are only effective when many people from different backgrounds come together and dedicate themselves to this common goal. Over the past three years, our collective results include saving hundreds of millions of dollars in otherwise fraudulent health care expenditures and putting away unscrupulous individuals who prey on those most susceptible to fraud including senior citizens and those who struggle with addiction.”
“But what I’m most proud of,” Spear continued, “is that through this work, we have formed incredibly strong cross-sector partnerships that have allowed us to expand our work on behalf of the communities we serve to prevent drug misuse and promote long-term recovery. We strive to go beyond the role of a typical anti-fraud department by leveraging our relationships with federal law enforcement and community leaders to positively impact our youth.”
Highmark West Virginia and the FBI Pittsburgh’s Charleston, W.Va. Resident Agency teamed up to create a video that explores the multi-generational harms of opioid misuse on the individual, family members and the community. The video features real-life, personal stories of dangerous opioid use and addiction, educational resources, and various tools available that focus on prevention for students and families. The video can be viewed by visiting this link: https://www.youtube.com/watch?v=pZz6k-vKs3k
Collectively, Highmark, the FBI and the West Virginia Department of Education provided these opioid education resources to more than 1,100 middle and high school teachers, reaching an estimated 136,000 West Virginia youth.
“The opioid epidemic has exacted a long-lasting social, emotional and financial toll on our state and on our nation,” said Highmark West Virginia President Jim Fawcett. “We live in the communities that we proudly serve. Many of us have lost a friend or a loved one to the chronic disease of opioid use disorder, or we know someone who has. We are proud to work with the FBI, the Department of Education and communities across our state to educate young West Virginians about the harms of opioid misuse, break the stigma of seeking help, and link them to recovery supports.”
The West Virginia initiative was inspired by an in-person FIPR program, launched in 2017, that engaged nearly 9,000 students, parents and educators in western Pennsylvania through its Opioid Epidemic Education Program. The program empowers people with knowledge and resources to respond to opioid dependence in their communities. For that effort, FIPR earned an Excellence in Public Awareness award in 2019.
Highmark’s FIPR department has collaborated with law enforcement on more than 210 health fraud-related cases over the past three years, many of which include cases involving drug-related fraud.
In 2023, FIPR is exploring partnerships with colleges and universities that offer pharmacy and physician assistant programs to provide education and resources on appropriate opioid prescribing and preventing health care fraud.
About Highmark Inc.
One of America's leading health insurance organizations and an independent licensee of the Blue Cross Blue Shield Association, Highmark Inc. (the Health Plan) and its affiliated health plans (collectively, the Health Plans) work passionately to deliver high-quality, accessible, understandable, and affordable experiences, outcomes, and solutions to customers. As the fourth-largest overall Blue Cross Blue Shield-affiliated organization, Highmark Inc. and its Blue-branded affiliates proudly cover the insurance needs of approximately 6.8 million members in Pennsylvania, Delaware, New York and West Virginia. Its diversified businesses serve group customer and individual needs across the United States through dental insurance and other related businesses. For more information, visit www.highmark.com.
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