Fraud is Bleeding America’s Healthcare System

Health care fraud is nothing new, but it continues to have devastating consequences for consumers. The good news is the same people who suffer as a result also have the ability to help put a stop to fraud.

Sadly, fraud happens all too often. The result is higher health care premiums, fewer people being able to afford treatment, and even legitimate claims being denied. This fraud is bleeding America’s health care system and it has to be stopped.

Greed Trumps Ethics

While you’d like to believe everyone wants to do the right thing, many are just out for themselves. For instance, a doctor you trust might give you a false diagnosis in order to collect more money from your insurance provider or Medicare.

Not only does this make the patient suffer emotionally and physically, it still happens. Dr. Farid Fata admitted to 13 counts of health care fraud in 2014. He gave infusions to 553 falsely diagnosed patients and earned $34 million from Medicare and insurance providers as a result. His final reward was 45 years in prison.

Of course, this isn’t the only case. In 2018, Mashiyat Rashid, CEO of Tri-County Wellness Group, was brought up on health care fraud charges totaling $150 million. The fraud involved prescribing unnecessary opioids and injections.

A Growing Financial Toll

Tens of billions are lost to fraud every year. This accounts for 2% to 10% of all health care spending. And there’s no end in sight.

In 2018 alone, the Department of Justice was able to recover $2.5 billion from false claims and health care fraud.

The Office of the Inspector General and the Department of Justice joined together to take down over 600 individuals involved in fraudulent Medicare and Medicaid schemes. The losses from the fraud totaled $2 billion.

Of course, consumers are the ones who end up having to recover those losses. This leads to increasingly high insurance premiums and insurance providers being even more strict on what is and isn’t covered.

Numerous Health Care Fraud Schemes

The worst part is it’s not always easy to uncover health care fraud. It comes in many forms, such as:

  • A false diagnosis
  • Unnecessary procedures and prescriptions
  • Stolen medical identities to provide false care
  • Medical identity theft to file false claims under another patient’s name
  • Group schemes to prescribe opioids
  • Providing fraudulent test results, such as urine tests, for drug users
  • Excessive charges for legitimate services
  • Double billing

What You Can Do

The most important thing you can do, whether you’re a patient, family member or medical professional is to immediately report anything suspicious to the proper authorities. If you don’t agree with a diagnosis, get a second opinion from a different medical provider.

Any medical center should also have an anonymous whistleblower hotline in place to safely report any potential fraudulent activity. It’s better to report something and it turn out to be nothing than to watch the health care system be further bled.