Does Health Insurance Fraud Affect You?

Yes, it certainly does, health insurance fraud affects every single US citizen.

You may or may not be aware of the enormous amounts of money being defrauded from the government by various companies and organisations. In fact the US government loses billions of dollars every year thanks to unscrupulous companies in all kinds of industries. These fraudsters cream off money, which rightfully should go into the government pot, with health insurance fraud coming close to top of the list.

It is estimated that in excess of $30 billion is defrauded each year by the healthcare industry alone.

Think about it for a minute, have prescriptions gone up lately? This is just one small way that you are paying for those who have committed health fraud. The government has to try and recoup some of the money lost, if it must continue to shore up the health care sector.

How can you help to prevent health insurance fraud?

  • Everyone can help in their own way, just by taking more notice and asking more questions, for example, if a doctor suggests further procedures or services, don’t be afraid to ask what the cost is and are they really necessary.

  • Be careful who you give your health card id or insurance information to; these hold information of the benefits you are entitled to, and in the wrong hands could lead to possible health fraud.

  • Finally if you know of, or suspect any wrongdoing or fraudulent activities within the health care or any other sector, you should have no hesitation but to report it.

    • In the first instance you should seek the advice of a Qui tam lawyer, who will be able to explain the process. Health fraud cases can sometimes be very long and complicated, but also very rewarding. Firstly from a moral perspective, knowing that you have done the ‘right thing’ in perhaps saving the US government millions of dollars in otherwise lost revenue. Secondly by being rewarded for passing on the information in the first place.

    Who commits health insurance fraud?

    Most people if asked this question would inevitably say, criminals, and of course they would be right, but sadly its not just criminals who are now cheating the government. It would appear that hospitals, doctors, administrators have all got in on the act and the biggest culprits of all are the pharmaceutical companies.

    Is it too easy to defraud the healthcare sector?

    Many would say yes. How can it be possible for hospitals and other health care facilities to be able to claim for the services of doctors who either don’t exist or are long dead? Others feel that it is far too easy for doctors and hospitals to bill Medicare or Medicaid for drugs never prescribed or for treatments that were never needed. Or additionally equipment that was never required or even charging for work that had never been carried out. These guys are just small fry compared to the large pharmaceutical companies who defraud not only the government but also the taxpayer of millions of dollars every year.

    In 2009/ 2010 AstraZeneca had to pay $520 million for promoting an anti-psychotic drug that had never been passed by the FDA and also for paying kickbacks to physicians.

    This was peanuts when compared to the year before, when Pfizer was fined $1.2billion for illegally promoting a number of their drugs for uses that had not been approved by the FDA.

    It would appear that the pharmaceutical industry really does not like playing by the rules; it continually defrauds both the government and the American taxpayer. Just imagine what the monetary reward may have been if you had been a whistleblower on either of the above cases!

    Reporting health insurance fraud really is the right thing to do, whether it is on a large or small scale.