Medical Fraud Has Taken a Toll On America’s Healthcare System
Medical fraud is a problem that has plagued America’s healthcare system from the start, and it’s a big reason why health insurance costs have skyrocketed in the past decade or so. The proposed healthcare reform bill currently circulating through Congress does contain many new anti-fraud programs that are designed to reduce, or ultimately eliminate, the amount of medical fraud across the country.
The worst part about the whole medical fraud debate is that no one actually knows to what extent medical fraud affects our healthcare system. Most estimates say that medical fraud accounts for between $60 and $600 billion annually – That’s quite a wide range! That being said, even if the true numbers are on the lower side of that scale, $60 billion is still a lot of money to be wasted. Just think about how that affects your health insurance premiums.
Medical fraud takes on many faces, but the most common case is when the perpetrator gains access to a list of patients, makes up any number of fictitious doctor names, and bills insurance companies for services they claim the fictitious doctors performed. By the time the insurance company finds out about the scam, the thief is long gone.
Much more regulation needs to be put into place when it comes to medical fraud. Americans are spending an obscene amount of money “paying back” all of this stolen money that the insurance companies lose to fraud. Hopefully, this new healthcare reform bill (if passed) will help reduce the amount of healthcare fraud as Obama claims it will. Our healthcare system throws around about $2 trillion annually, so it’s definitely an area in our economy that could use some fixin’.
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August 18th, 2009 at 5:25 pm
Good Post: As RN for over 23 years and now a Legal Nurse Consultant I can attest to what you say, I have seen clinics that have have a totally fake patient list on the computer and they bill medicare for same day surgery procedures like plastic surgery.
August 20th, 2009 at 10:48 am
A part of what makes the fraud numbers so hard to determine is likely the health insurance companies not wanting make the numbers public. If you are the health insurer and suffer from a higher amount of fraud than other insurers, that would likely make individuals less likely to purchase insurance from you. Keeping this in mind, it would likely make sense for the government to legislate that insurance companies to have to publish their known fraud charges. I am sure that this would give the insurers far more incentive to fight fraud and pass less of the costs onto those legitimately paying for insurance.