The Healthcare Problem of Fraud

There is a health care problem which costs consumers every time they visit a health care provider, every time they pay for health insurance, and costs them money as taxpayers too. This problem is health care fraud. Consumers need to know what it is, how it costs them, and how to protect themselves from this problem.

Blue Cross Blue Shield defines health care fraud as "an intentional, unlawful and sometimes repetitive deception that costs every insured American about $200 per year."1 The FBI describes health care fraud as "a burgeoning crime plague that's adding up in a big way, big-ticket scheme after big-ticket scheme, essentially costing you money every time you walk into a hospital or doctor's office or fill a prescription."2

Almost anyone involved in a medical claim could commit health care fraud. Patients, medical equipment suppliers, doctors, pharmacists, clinics, hospitals, nursing homes, practitioners, nurses, billing companies, medical providers' employees and insurance companies' employees could commit this crime. Fortunately most involved in the health care system "are honest and ethical and are victimized in the same way most Americans are victimized." The crime is "committed by a very small number of people. Yet the impact is costly and significant." [1] The Associate Deputy Director of the FBI Joseph L. Ford states "there's literally millions of ways to defraud health care."[2]

The Washington Post reports health care fraud "costs taxpayers more than $60 Billion a year."[3] The FBI states "government health programs like Medicare and Medicaid, are a favorite of health care scammers and account for some 44 percent of all health care fraud. Losses total more than $100 billion annually."[4] "National Health Care Anti-Fraud Association estimates 3 percent of overall health care costs is due to fraud."1 Fraud costs us all as consumers, taxpayers, and companies.