Consumer Law

3-10% of Health Care Funding Goes to Fraudulent Claims

By M. Stan Herring

The Health Care Lawyer Blog has posted an article about the amount of health care funding that could be saved from fraud every year. There is about $75-$250 billion "floating about in the health care system." Around 3-10% of that is lost to fraudsters annually.

these numbers make clear that health care fraud is not just committed by a few scattered criminals masquerading as health care providers. Instead, such fraud is pervasive and extends all the way from Pfizer boardrooms to infusion clinics.

The article lists five ways to curb health care fraud:

-"The government should scrutinize individuals and entities that want to participate as providers and suppliers, BEFORE they enroll."

-Make sure payments reflect the current market. Such as not making a huge payment for a procedure that is now "inexpensive and commonplace."

-"Assist providers and suppliers in adopting practices that promote compliance."

-Abandon the "pay first, ask questions later" approach and instead monitor health care systems for fraud. Technology should be used to identify incorrect claims before the provider is reimbursed.

-Respond quickly to detected frauds and deter others. For example, the use of Health Care Fraud Prevention and Enforcement Action (HEAT) teams to catch Medicaid fraud has been met with success; Since the inception of Strike Force operations in March 2007 through August 2009, the Strike Force has obtained indictments of more than 293 individuals and organizations that collectively have billed the Medicare program for more than $680 million.

If you have had issues relating to fraud, feel free to contact us.

Full post as published by Alabama Consumer Blog on September 15, 2009 (boomark / email).