Anywhere that money can be made, you can find fraud and scams. In July this year, 412 people were charged for their part in health care fraud schemes that amounted to $1.3 billion in false billings. Many of the people charged were doctors and other medical professionals. The scheme involved charging for unnecessary prescriptions that the patient often never received. While this is a large case, it’s certainly not the only instance of medical fraud in the US. Some fraud involves Medicaid or Medicare, as well as private health insurance companies, hospitals, and other institutions and organizations.
Medical fraud isn’t always easy for people to spot. It’s often someone “on the inside” who raises the alarm because they’re more likely to see it happening. These people then often need to seek a whistleblower lawyer in order to protect themselves and get help proving the fraud that is occurring. While the government has tackled some big instances of health care fraud, they don’t have the resources to take care of everything. So it’s left to private individuals to help when they see something that’s illegal and morally wrong. Individuals can file a qui tam suit, which allows them to sue on behalf of the government.
Medical fraud is often related to drugs, and particularly opioids and other narcotics. According to the Attorney General Jeff Sessions in July, a group of doctors provided unnecessary opioids to many patients and billed Medicare $164 fraudulently. He also mentioned a fake rehab, among a total of 295 health care providers to be suspended or banned from federal health programs. Tackling these issues is part of the effort to deal with the opioid crisis, which has also involved efforts to reduce prescriptions. However, these did decrease by 18% between 2010 and 2015.
People can try to be more vigilant in spotting medical fraud if they educate themselves about some common scams. Some of them include billing for services that weren’t provided, misrepresenting information such as dates or locations, and false or unnecessary prescriptions. It’s not always easy for an individual to do something on their own, but if you ever think anything is incorrect, a lawyer or a private investigator could help you. Rather than identifying an issue in your own treatment, you might be more likely to do so if you work in the health care industry.
The FBI does dedicate itself to investing health care fraud, but they aren’t able to cover everything. The Complex Financial Crime Program covers investigations into medical fraud and they also have the help of other organizations, such as the FDA. They also warn against the theft of patient’s medical information and suggest being careful when dealing with health care providers online especially. With health services increasingly becoming more available online, including online doctors, this is an important thing to consider. But even when dealing with health care providers in person, it’s important to be careful with your information and know what they’re doing with it.
Health care is big business, and so is health care fraud. Although government agencies are tackling it, it’s often up to individuals to help.