Healthcare fraud affects everyone

Reference no: EM133656630

Healthcare Fraud affects everyone, and can cause billions of dollars in losses each year, like most white-collar crimes.

The Affects of Healthcare Fraud:

It can raise health insurance premiums (consumers, workers)

Expose individuals to unnecessary medical procedures (consumers)

Increases taxes (public)

Who commits Healthcare Fraud? Anyone who looks to defraud the healthcare system for benefits and payment. These people can include:

Medical Providers: One common fraud is a "gang visit," when a provider visits a nursing home and invoices for services as if they had treated most residents. Alternatively, a provider may perform a service regardless of whether each resident needs it.

Patients: Submitting false information to obtain coverage or receive medications, Or impersonating a healthcare professional.

Workers: They can use someones medicare card if they are the beneficiary, to get medical care, supplies or equipment.

Example of Healthcare Fraud

One real life example of Healthcare Fraud would be the Telemedicine Fraud. This scheme resulted in over $2 billion in fradulent claims. The former CEO, and Vice President of Business Development of purported software and services companies conspired to generate and sell templated doctors' orders for orthotic braces and pain creams in exchange for kickbacks and bribes. The conspiracy allegedly resulted in the submission of $1.9 billion in false and fraudulent claims to Medicare and other government insurers for orthotic braces, prescription skin creams, and other items that were medically unnecessary and ineligible for Medicare reimbursement, according to the Office of Public Affairs press release. This scheme targeted the elderly and disabled with direct mail, television advertisements and other forms of advertising to induce them to contact offshore boiler-rooms staffed by individuals who "up-sold" their targets on unnceccary medical equipment and perscriptions.

Reference no: EM133656630

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