Uncovering the Over $100 Billion Impact of Healthcare Fraud Schemes 

August 11, 2023
Uncovering the Over $100 Billion Impact of Healthcare Fraud Schemes 

Healthcare fraud schemes have cost the U.S. government, taxpayers, and insurance companies well in excess of $100 billion annually. If you think the government isn’t taking any alleged fraud seriously – or anything that even resembles fraud – think again as the integrity of Medicare system depends on rooting out fraud and abuse

Congress has introduced whistleblower programs like the False Claims Act to protect and reward those who come forward to report fraud. The False Claims Act offers protections against retaliation and provides the possibility of monetary awards for whistleblowers of up to 30% of what the government recovers, which over the last decade in the aggregate has been hundreds of millions of dollars in whistleblower rewards

The bravery of whistleblowers in exposing fraudulent activities is critical in the fight against healthcare fraud and other fraudulent schemes such as PPP loan fraud, CFTC commodities fraud, SEC securities fraud, IRS income tax fraud, and NHTSA highway safety fraud, which is where firms like our whistleblower law firm come in. To file a False Claims Act whistleblower case and be eligible for an award, you must hire a whistleblower law firm, and Brown, LLC has been assisting clients nationwide with their whistleblower cases with hundreds of millions of dollars in settlements and judgments, although past results don’t guarantee future success.   

Medicare and Medicaid Fraud: A Significant Burden to the Taxpayers and the System

Healthcare fraud has cost taxpayers hundreds of millions of dollars each year, impacting not only finances but also patient health. Unnecessary procedures and prescriptions, along with inadequate medical care, pose risks to patients’ well-being. Detecting and preventing fraud is crucial to protect healthcare resources and ensure patient safety. If you suspect fraud or have been affected by it, seek assistance to protect your rights and thereby help contribute to a healthcare system prioritizing patient well-being and effective resource utilization.

Common Healthcare Scams and Frauds in the U.S.

Healthcare fraud has become a lucrative business, with fraudsters employing deceptive tactics. Dummy corporations bill Medicare and Medicaid for fake COVID tests, non-existent medical equipment, and fraudulent genetic testing. Some even invent patients, submitting claims for services on behalf of non-existent individuals. These schemes not only defraud the government and insurers but also jeopardize patient care and escalate healthcare costs for taxpayers. Detection, prevention, and awareness are crucial to safeguarding the healthcare system and ensuring genuine patients receive proper care.

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Fraudulent Billing and Overbilling

Other healthcare schemes may include billing for tests that weren’t run or fake appointments for existing patients or exaggerating lengths of the encounter. In these cases, an unscrupulous health care provider may bill for more procedures than they actually performed, wrongly receiving reimbursement from the insurer. Overbilling is another common type of fraud, charging an insurance company more for procedures and services than actually performed.

Medical Identity Theft

Fraud committed using the names of existing patients is considered medical identity theft. It’s committed when someone uses a patient’s name and social security number to submit fraudulent claims to an insurance company or Medicaid without their consent.

Financial Impact of Healthcare Scams

The U.S. Department of Health and Human Services (HHS) oversees Medicaid and Medicare. In 2021, 0.02 of every dollar of the HHS’s budget was allocated for oversight and fraud investigation. Medicaid and Medicare together cover roughly 150 million beneficiaries, with annual spending of more than $1.635 trillion, so even just a couple of pennies on the dollar adds up to a substantial fraud oversight budget. Even with $32.7 million to spend for oversight, more and more fraudsters slip through the bureaucratic cracks.

Causes of the Recent Rise in U.S. Healthcare Scams

Because there are just so many people on Medicare and Medicaid rolls, and because now nearly everyone in the U.S. has health insurance there may be just too many patients for oversight and regulatory bodies to keep up with. The rise in healthcare schemes is tied to just how easy it is for swindlers to rip off the government and without insiders disclosing the scams it may take years for the government to catch up.  For example, with the prevalent PPP Loan fraud, billions were given out hastily and its just now the government is realizing that billions of those billions were outright fraud.  Similarly, with Medicare fraud, it takes time to catch up, but when the government does there can be civil and criminal consequences. . 

Healthcare Fraud Affect Everyone

Everyone pays for medical fraud. The more the government wastes on Medicaid and Medicare fraud, the more it costs taxpayers. Higher medical costs also mean higher insurance premiums. It can also directly affect patients. If certain false tests or procedures are billed to legitimate patients, they could show up on the patient’s health records. This affects how a patient is diagnosed, either by a missed diagnosis of a legitimate medical issue or by diagnosing someone with an illness they don’t have.

Detecting Healthcare Scams

Detecting healthcare fraud is challenging. The patients themselves may not know enough to detect waste or fraud, so for the most part, it’s up to the people working inside the institutions who can keep an eye out for the red flags mentioned above and report it. There are many risks of knowing and not reporting fraud, it can always bite you back and put you and your career in harm’s way so it’s always best to consult with a whistleblower law firm who can help you understand your rights as a whistleblower and guide you.

How Can You Report Healthcare Fraud?

At Brown, LLC, we recognize the severity of healthcare fraud and its impact on individuals and society as a whole. Our law firm is committed to providing effective legal representation to the whistleblowers who come forward to report such fraud. We offer a free and confidential consultation to potential whistleblowers to discuss your case and explore your legal options.