How Common is Healthcare Fraud?

If you suspect or observe fraud, you have to know the guidelines for whistleblowers (someone who secretly reports fraudulent activities) to keep yourself legally protected. Consult a lawyer as soon as possible. 

Health insurance fraud is an example of healthcare fraud wherein an individual or insurance company defrauds an insurer or Medicare or state healthcare program. Medical fraud and drug fraud are also considered healthcare fraud, which represents billions of dollars of wasted money. 

While many people are suffering from various medical conditions, individuals and companies take advantage and leech money using healthcare services. The integrity in the healthcare system is ruined by the impacting results of healthcare fraud. 

But, how common is healthcare fraud? In this post, you’ll learn more about healthcare fraud and its current occurrence, status, and impacts. 

What Statistics Show: Problem Areas at Risk for Healthcare Fraud 

In a study conducted by PKF Littlejohn LLP, along with the University of Portsmouth, the authors show the average percentage lost in the healthcare system increased from 5.59 percent in 2007 to 6.19 percent in 2013. This data equates to $7.35 trillion of the total global healthcare expenditure, which is an enormous amount diverted from the supposed provision of quality patient care. 

Here are the most common fraud areas in the healthcare system: 

• Contractors: Error, corruption, and fraud related to long-term care or home- and community-based healthcare services, including foster and child care and insurance fraud 
• Medical Professionals: Some examples include prescription fraud committed by pharmacists and error and fraud concerning payments for consultations, facility services, and medical tests. 
• Patients: Some examples of healthcare fraud involving patients include fraudulent acquisitions and provision of medical certificates, evasion of medical charges, and prescription fraud. 

If you suspect or observe fraud, you have to know the guidelines for whistleblowers (someone who secretly reports fraudulent activities) to keep yourself legally protected. Consult a lawyer as soon as possible. 

Medicare and Medicaid Fraud 

Medicare and Medicaid fraud involves doing illegal practices to get high payouts or reimbursements from government healthcare programs. This results in multi-billion dollar expenditures that are perceived as damaging liabilities. That’s why the government and the healthcare sector face healthcare fraud as a huge obstacle towards providing fair and quality patient care for all.

Here are solutions to address Medicare and Medicaid fraud: 

• In 2018, there was a new program implemented by Medicare, in which Medicare participants obtain new ID cards with a Medicare Number included, instead of a Social Security number. This program aimed to help prevent fraud related to identity theft. 
• External and internal auditors work together to monitor fraudulent activities. 
• Develop healthcare programs or policies bound with strict security features to avoid corruption. 

Telehealth Fraud is Also Trending

Telehealth fraud is a form of healthcare scam that involves improper medical coding. With telehealth or telemedicine, people are encouraged to seek medical consultation through online technology for convenience.

However, as telehealth expanded, it was exposed to abuse, and fraud continues to increase, which resulted in $2.1 billion losses in the United States. One example of telehealth fraud schemes includes improper billing. 

Here are some improper billing practices in telehealth fraud: 

• Healthcare claims were falsely listed as “rural area” claims but actually came from “urban areas.”

• Increased healthcare claims from institutional providers that aren’t qualified. 

• Claims from illegally made or tampered prescriptions are being approved.

Expensive Medicines: Result of Pharmaceutical Fraud

Pharmaceutical fraud or drug fraud refers to illegal practices in which fraudulent claims to healthcare programs are influenced by pharmaceutical companies. It includes mislabeling the billing of a government-funded healthcare program that’s forwarded to the government. Also, it includes manufacturing ineffective or even dangerous drugs, then selling them at high prices.

Pharmaceutical fraud is worldwide. While there are whistleblowers who come out, their lives are always in danger as wealthy drug companies hunt them down to keep them silent. One of the pharmaceutical fraud whistleblowers is Dinesh Thaku. He’s a U.S.-educated engineer who exposed fraud committed by Ranbaxy Laboratories, a famous Indian pharmaceutical company that has been accused of faking medical drug test results.

Here’s how you can protect yourself when whistleblowing healthcare fraud: 

• Consult a medical fraud lawyer to know your legal options. 

• Ask your lawyer how the government can protect you and your family with a shocking revelation you’ll honestly tell in court. 

• Don’t talk to anyone until you have spoken to a trusted medical fraud attorney.

Conclusion

Healthcare fraud has always been a problem worldwide. While there are whistleblowers who come out and tell the world how fraudulent schemes are being done, many insurance companies, healthcare facilities, and even medical professionals themselves commit such acts. 

These ill practices don’t only drain people’s money but also the right amount of healthcare funds that should be utilized in improving healthcare services.