Healthcare News & Insights

Health care fraud up 30% — expected to get worse in ’10

A recent report highlights just how widespread health care-related fraud is — and why the feds are looking to ramp up enforcement.

Health care settlements and judgments recovered by the feds tallied $1.6 billion — that’s up 30% from the year before. About $867 million of that came from pharmaceutical and medical device companies.

The recovered funds were secured under the False Claims Act (FCA) prosecutions. FCA allows the feds to prosecute any fraudulent billing of government programs — but roughly two-thirds of the cases last year involved health care.

No wonder the Dept. of Justice recently said that health care fraud would be one its top enforcement priorities in 2010.

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  1. Don Stumpp says:

    Shocking! But what is the real story? Up 30% but in real dollars that is $369 million. Same day this news tidbit hit my inbox, this one did also:

    U.S. healthcare spending rose 4.4% in 2008, the lowest rate on record, but still reached $2.3 trillion and comprised 16.2% of the U.S. economy.
    Source: “CMS ISSUES ANNUAL REPORT ON NATIONAL HEALTH SPENDING,” Centers for Medicare and Medicaid Services press release, January 5, 2010.

    So 1.6 billion is .07% of $2.3 trillion. Is my math right?

    I am certainly NOT implying we should turn our back to fraud. The parties involved need to be prosecuted. But as a medical provider, I just want there to be some perspective. Out of the $1.6 billion, $867 was not from medical providers. Over half. I also wonder if some ‘fraud’ is merely a disagreement on a procedure for medical appropriateness versus blatant fraud.

    Articles and headlines such as this paint the medical community as unscrupulous to those who dont bother to know the real facts.

    Final note, I’d be interested on the the total dollars insurance companies have paid in fines or settlements in the same period.