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Combating Health Care Fraud, Abuse and Waste

Our health care system is failing in so many ways, and legislation is unlikely to fix the problems. In 2009, we each spent about $8,000 on health care. This totaled $2.5 trillion, or nearly 18% of the country’s gross domestic product. Unfortunately, about a quarter of this budget was not for health care, but for fraud! Here are some recent fraud statistics.

• Medicare and Medicaid billing errors resulted in $108 billion in improper payments.

• Fraudulent health insurance claims accounted for $33 billion in losses.

• Inappropriate private payments cost approximately $100 billion.

• Medicare fraud costs us about $68 billion.

• Fraudulent insurance payments are costing us $50 billion.

• Payments for medical errors amount to approximately $38 billion.

• About 10% of prescription drugs are counterfeit, costing about $12 billion a year.

All of this means that we are wasting an estimated $25 million per hour on medical fraud, waste and abuse. It’s way too much and it’s something we should all be concerned about because in one way or another we are all paying the price. We pay for it in higher taxes, higher medical costs and higher medical insurance premiums. The government does not “eat” the cost of medical fraud, waste and abuse. Neither insurance nor doctors. The costs, as with all fraud, are simply passed on to consumers. You and me. We pay for fraud.

Medical fraud is committed everywhere, by just about everyone. Here is a short list of groups that commit health care fraud. Recognize it?

Who commits medical fraud

• Criminal groups

• Employees who approve claims for themselves or friends

• Suppliers

• Vendors and Suppliers

• Insured patients

• Uninsured patients

One of the attributes of this system that makes it so vulnerable to fraud is that so many players are involved in delivering a service to a patient and then paying for that service. The first actors in the system are the patient and the healthcare provider. However, it doesn’t stop there. Once the patient has seen the provider, the payer (patient, insurance company, government) enters the process. They are tracked by the employer who may pay some or all of the patient’s insurance premiums and/or pre-tax medical savings accounts, and vendors (e.g. pharmacies, pharmaceutical companies, equipment vendors and manufacturers medical). Medical frauds are complex and often involve at least three of these actors.

Fight against fraud, waste and abuse

So what can be done? We don’t need another study by a government committee. We need action. We have to start with consumers and citizens. A comprehensive fraud prevention program to combat fraud begins with anti-fraud education for consumers and citizens. Everyone needs to know how pervasive medical fraud is and what it costs each of us. An effective anti-fraud program starts at the local level with consistent and comprehensive attention. One mainstream media story every six months will never be enough. Only when citizens know what the problem is and what it costs will they fight the status quo.

The more technical elements of an anti-fraud program to combat healthcare fraud, waste and abuse include:

• Fraud Prevention Programs – internal control systems within all healthcare organizations to make it harder for individuals to commit fraud. Adequate review and approval processes coupled with good oversight are the cornerstones of an internal control system.

• Fraud deterrence programs – activities that increase the likelihood that fraud will be detected if it exists. The most common example of a fraud deterrence program is the conduct of frequent proactive fraud audits. These are audits that are conducted to uncover fraud when there is no indication that it exists.

• Fraud detection programs – data mapping, extraction and analysis processes to detect fraud when it exists.

• Fraud investigation programs – responsive auditors and investigations conducted when there are indications that healthcare fraud has occurred.

• Fraud loss recovery programs – the payer, whether an insurance company or the government, must recover funds lost to fraud and medical abuse. US Code 18 USC Sec 983(c)(3) asserts the right to force the forfeiture of assets if the government is able to establish that the assets were used, facilitated, or involved in the commission of a criminal offense, and that there was a connection between the property and the offence.

• Punishment of the perpetrator of the fraud – people who commit fraud carry out a cost-benefit analysis and generally determine, at least subjectively, that the cost of fraudulent activities (the risk of detection, prosecution and punishment and the cost of the sanction imposed in the event of a sanction) is less than the assets (money) earned through the fraudulent activity. When the perceived benefits far outweigh the perceived costs, fraud becomes a rational economic decision. Only by increasing the probabilities of detection, prosecution, and punishment, as well as the severity of the penalties, can the cost-benefit analysis be biased so that the costs outweigh the benefits.

Conclusion

The battle against medical fraud, waste and abuse starts with you. Become an informed consumer. Let your Representatives and Senators know that you are tired of paying for medical fraud. After all, the money the government spends is your money. Ask your doctor and other healthcare providers what they do in their practice to reduce the risk of fraud. Send a note to your insurance company and ask what they are doing. You could provide them with some suggestions from the list above. Become a grassroots activist in the fight against fraud and abuse. You can help reduce the costs of medical care.

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