Health Care Fraud

Health care fraud is a multi billion dollar business. Fraudulent businesses are set up around the nation and employ creative criminals who bilk both young and old alike out of their money.

From unnecessary procedures to over billing and fictitious patients this multi billion dollar business has made life difficult for the real patients requiring real medical care. Go into any hospital and you’ll find that you have to fill out a stack of forms. Why are they so detailed? Because if they can find a way to get another company to pay for the injury, they are going to do it. Ridiculous you say? Let’s take a look at some facts.

In the hospital emergency room a patient fills out a paper trail about how they injured themselves. At home and a few days later they receive an envelope in the mail from the insurance company requiring the same information. Then the doctors office sends another form to be filled out. Pretty soon the paper trail is so long that the patient is frustrated and angry after all, it was only a small injury.

Another common health care fraud is identity theft. Someone who has legitimate access to a hospital’s computer system logs in and gather patient information. This is then sold to an organized criminal group.

The criminal group then turns around and hacks into the digital medical records in order to steal money from the Medicare system which makes the government the largest victims of health care fraud. Rob Montemorra, chief of the FBI’s Health care fraud unit, found this to be a $450 billion dollar business.

Stolen information includes details such as medical insurance information, Social Security numbers, and personal information. The criminal then fraudulently bills the insurance company or Medicare for drugs, treatment and equipment. They then bill the company two to three times the actual cost of the medications, treatments and pocket the difference.

Occasionally medical information is sold to desperate people who have no insurance so that they can get medical care themselves.

Bogus companies send out the billings, these companies usually disappear as soon as an investigation has begun. Leaving just enough time to collect a few hundred thousand to a few billion dollars from the health care industry.

These criminal activities also affect the patients whose information has been compromised. Their medical information is frequently tampered with which can put their health at risk as well.

Victims also lose out having to spend a lot of time back tracking their information to get it straightened out. Sometimes this results in a loss of time from work or long distance calls. The cost to the innocent victim was averaged at $1,200.

In 2008 the criminals made over $19.000 per act of health care fraud. That’s four times the dollar amount they gained in the overall Identity theft.

Everyone who pays taxes is a victim this fraud costs the taxpayers. It’s coming out of their pockets. In 2009 alone, $47 billion was paid out in questionable Medicare payments.

In 2009 the FBI had 2,494 pending fraud investigations. With 1,069 pleas, indictments and complaints. They had 640 convictions and the cord ordered restitution of $1.6 billion dollars.

How is the FBI working to stop these crimes? They’re urging citizens to guard their health insurance information. Be wary of free health care services, review medical bills including explanations of benefits. Review hospital and doctors bills. If something seems odd ask about it. Ask the clinic or hospital why a test was run or question if you don’t think it was run. Report any inaccuracies to your doctor and the insurance company and find out how to make it right. If health care fraud is suspected, call the FBI and report the details they will follow up.