Healthcare Fraud

Healthcare Fraud in America

Kimberly Cummings

Columbia College

Abstract

Rising costs of everything from food to taxes is a daily reminder to everyone. One of these increasing costs is healthcare. Over the past 10 years, healthcare costs have risen three percent over the inflation rate. A major contributing factor to the rising costs of healthcare is fraud and abuse of the system. Fraud is knowingly and intentionally misrepresenting the facts. Three types of healthcare fraud are employee, provider and member fraud. Employee fraud includes filing a claim for an injury that did not happen on the job. Provider fraud, for example, consists of classifying employees as independent contractors to pay lower premiums. Finally, one type of member fraud would be not removing someone from a policy who is no longer eligible.

Health care fraud can be prosecuted both civilly and criminally by state laws or federal laws under a variety of statutes and regulations including the Federal Civil False Claims Act. The U.S. Departments of Justice, Health and Human Services', the Office of Inspector General and the Federal Bureau of Investigations are all involved in the investigation and prosecution of healthcare fraud. Healthcare fraud increases the costs of insurance and medical services. Continued prosecution and recovery of fraud money will possibly deter future fraud and abuse of the healthcare system and money recovered from fraud can be returned to the government.

Rising costs of everything from food to taxes is a daily reminder to everyone. One of these increasing costs is health care. Over the past 10 years, healthcare costs have risen three percent over the inflation rate and healthcare premiums have increased over 131%. (Colliver, 2009) A major contributing factor to the rising costs of healthcare is fraud and abuse of the system. According to National Health Care Anti-Fraud Association, in 2009, the U.S. spent more than 2 trillion dollars annually...