Health Care Fraud Becomes Big Business And Receives Attention From Prosecutors

Bad news for those who intend to defraud the government of millions of dollars for health care related expenditures. According to the Department of Justice and the Wall Street Journal, prosecutors have filed a record number of health care fraud cases this past year.

A Freedom of Information Act request by researchers revealed that prosecutors pursued 377 separate health care fraud cases in the fiscal year that ended last October. That number represents a three percent increase over the previous year and a nearly eight percent rise over the number from five years ago.

Experts believe that the increase in health care fraud prosecutions reflects a growing awareness that such fraud is costing the government, and consequently taxpayers, literally billions of dollars each and every year. By making a public spectacle of pursuing those who break the law, the hope is that an important message is sent to others who might be considering engaging in similar fraud.

Though experts are not willing to say that the increase in prosecutions is tied to a corresponding increase in criminal behavior, they do think it is a sign that the federal government under President Obama has made it a priority to crack down on those that are enriching themselves at the expense of unsuspecting taxpayers.

A good example for how much energy has gone towards these fraud prosecutions came last May when a total of 89 individuals across eight cities were charged for their roles in schemes designed to defraud Medicare of more than $220 million in fake health care charges. Of those charged, 14 were doctors and nurses, something that used to be far more of a rarity than it is today.

These instances of fraudulent billing are repeated across the country over and over and begin to add up. According to estimates from the federal government, it is believed that Medicare fraud alone costs the program between $60 and $90 billion each and every year. Though fraud used to be relatively simple and involved fake patients or unused medical equipment, experts say that today's crooks have grown increasingly sophisticated in an attempt to stay a step ahead of authorities.

For its part, Medicare is attempting to fight back. For years, the program operated under a pay-and-chase approach, meaning providers were paid for the claims they submitted and anything that ended up looking suspicious was investigated after the fact. Today, authorities say they have designed new software that is meant to review claims before they are paid and flag those that have the potential for being suspicious.

Whether the new approaches will be enough to slow down the multi-billion dollar health care fraud industry remains to be seen. Until then, prosecutors say they are ready to bring claims against those who are found to broken the law.


Report: Health care fraud cases hit high last year Associated Press, published by Wall Street Journal on January 15, 2014.

Report: Health care fraud cases hit high last year, by Jim Suhr, The Daily Journal, January 21, 2014.

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