If anybody really loves the Unites States health care system, then it's the hospitals, pharmaceutical companies, contractors and physicians that fleece the government out of somewhere between sixty to a hundred billion dollars each and every year.
Health Insurance Fraud - False Claims
Sadly it’s not just criminals who defraud the government and commit health care fraud. On the contrary, hospitals, doctors and even pharmaceutical companies will also try to cheat the system. There are many examples of hospitals that are billing for the services of doctors who are not even alive!
The types of people who commit these crimes are varied, from the highest levels of hospital administrators to one man doctors’ offices. These people can be very clever in the way that they operate. In fact to avoid arousing any kind of suspicion, they may set up complicated billing structures and try to cover their tracks. This can make it very difficult for health care fraud investigators to pursue a line of enquiry.
Qui Tam Law and Whistleblowers
The Government does have one ace up its sleeve and that is to bring in the qui tam law. This is a shortened Latin phrase which fully extended is 'qui tam pro domino rege quam prose ipso in hac parte sequitir'. Quite literally translated it says “he who sues in the name of the king, does so also for himself'. In layman’s terms what this equates to is that if a person reported a case of fraud against the government, then that person would be entitled to a share of the rewards. Therefore the government is in effect giving strong incentives for whistleblowers to report any health care fraud or health insurance fraud. If you have any information related to health care fraud you should really contact an experienced attorney to find out if you can help stop it, and if you can collect a monetary reward for doing the right thing. The Law Offices of David H. Greenberg is here to help so call us at 1-888-204-1014. We take cases from all fifty States so call us toll free from wherever you are.
False billing is one of the most egregious areas of health care fraud. Hospitals and physicians may bill Medicare for treatment, drugs or equipment that was never prescribed in the first place. An example of this is if you order unnecessary medical equipment such as a wheelchair. A doctor might order one of these for a person who is in no need of one. They will then look to bill Medicare for that wheelchair at a seriously inflated cost that equates to often 3 or 4 times the amount it would normally cost. The organization would then pocket the profit.
Health Care Identity Fraud
The main culprit in this sector of health care fraud may be identity theft. According to Louis Saccochio who is the executive director of the NHCAA (National Health Care Anti-Fraud Association), a government watchdog in which members include law enforcement personnel, regulatory agencies and insurance carriers, he maintains that after closely investigating the main reasons why fraud and abuse in health care exist, findings show that this type of health fraud accounts for around 60 percent of the total.
Health care identity fraud is big business and happens when somebody sells medical records containing all the information about a particular patient to organized criminals, who will use it for other criminal activities. Clearly medical records should be confidential and not something that any normal 'John Doe' can get their hands on. So what happens usually is that a person who has legitimate access to these records, such as a Hospital Administrator or even a Physician themself will sell this information on to the criminal groups for a tidy profit. In many cases the criminals would then sell these records on to those who are uninsured and are absolutely desperate to receive medical care. Needless to say these would be sold on for very high prices.
Medical record hacking
Another way that scammers and organized gangs commit fraud and abuse in health care is to hack into medical records that are stored digitally. From this they have a plethora of information such as social security numbers and medical insurance data, of which they can use for other means. This in itself is a multibillion dollar industry and as a result this makes the government the single biggest victim of health fraud.
Why Should the Public be Concerned?
So the government is losing out billions of dollars a year on health care fraud and abuse... how does this affect you directly? Firstly let's look at the costs involved. We have already mentioned that it costs the government somewhere between $60 and $100 billion dollars each and every year and in order to fund this loss; they have to increase health care premiums. You may have recently found a couple of cents has been added to the cost of your prescription, which is an attempt to recoup some of the money that they are haemorrhaging. On top of this, you may well find that you have been fraudulently billed for a treatment that you haven't had. The chances are that it will be sorted out, however when you take into account the hours of time that you might lose trying to solve the issue, then time is money.
Finally and rather more worryingly, tampering with patients medical records can be dangerous especially if one person's records are entered into another patient’s. This could lead to a misdiagnosis, or worse still treatment that is either not necessary or incorrect.
President Obama has decreed to come down hard on anybody who is seen to be committing health care fraud and is trying to get all records digitized. At present there are still a majority of records that exist on paper and it is this transition from paper to online records that could see an increase in the amount of incidents of fraud. President Obama has openly set a five year deadline in order to get all medical records digitized and to dramatically decrease fraud and abuse in health care. Whether this is really going to happen; only time will tell.Healthcare Fraud Articles