Physicians are placed in a position of trust, couple that with complicated lingo and a lack of understanding of medical practices, and fraud will be endemic. Often times the actions of the physicians are not questioned, as long as patient continues to improve. Healthcare fraud can be concealed in plain sight and innocent consumers – despite their diligence – may not see it. So who is responsible for finding it, reporting it, prosecuting it and invariably stopping it? If not stopped it will continue to increase.
The instance of healthcare fraud is estimated at about $80 billion a year. This is 3 – 10% of total heath care expenditures and it keeps rising every year. Trends show that with increases in undocumented citizens and the increase in cost of life expectancy fraud will continue to rise both in terms of dollars and as a percentage of costs. Schemes target public companies, private companies and beneficiaries. Fraud schemes are growing in sophistication but with increase in awareness at all levels companies and organization can help keep the numbers to a minimum. Though sophisticated, with the proper review and professional skepticism they can be detected. Early detection can prevent large schemes from perpetuating into schemes that can have catastrophic effects to an organization or the economy at whole.
Healthcare fraud may be at the tip of the iceberg for furtherance of other crimes such as money laundering and funding of terrorist activities. Additionally, as the fraud continues the quality of service – bring with it a decline in patient safety/care.
- Chief Audit Executives
- Insurance Claim Auditors
- Claim Adjusters
- Insurance Fraud Examiners
- Special Investigation Units
- Healthcare Providers
- Medical Billers
- HR Benefits personnel
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Contact: John Gordan