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December 24, 2012

In wake of fraud charges, Blue Cross redesigns wellness rewards program

Blue Cross and Blue Shield is committed to wellness incentives and has designed a new program that's more verifiable, a company official told the Kansas City Council last week. The new program does not involve self-reporting and is geared toward "outcomes and verifiable activities."

Blue Cross and Blue Shield is committed to wellness incentives and has designed a new program that’s more verifiable, a company official told the Kansas City Council last week.

The new program does not involve self-reporting and is geared toward “outcomes and verifiable activities,” said Gregg Laiben, medical director with Blue Cross and Blue Shield of Kansas City.

Laiben addressed the council one week after federal prosecutors filed charges against six Kansas City public employees and one Jackson County public employee for allegedly defrauding Blue Cross and Blue Shield, their insurance provider, in 2010 and 2011.

They allegedly claimed hundreds of thousands of dollars in cash rewards for participating in races and other exercise activities that they didn’t actually do, under the Points to Blue wellness incentive program.

Laiben said he could not comment on the court case. He said the Points to Blue program is ending Dec. 31, although he would not say whether that decision was related to the court case.

But he did say a new program will take its place Jan. 1 and will give points only to employees who complete verifiable activities, such as getting blood pressure checked, completing a survey on lifestyle, participating in educational seminars and engaging with a nurse or a coach.

The maximum reward in any given year would be $100.

Mayor Sly James commended Laiben and Blue Cross for reshaping the program to make sure clients actually participate in the wellness programs.

While six city employees face fraud charges, city officials are still trying to determine how many other employees supplied information used in the scheme and what discipline would be appropriate.

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