From compounding pharmacy fraud to medical billing fraud, there has been a sharp increase in both the frequency and the variations of medical fraud cases recently. It is an issue that needs to be tackled more seriously, and with better awareness, by both the new government, as well as the potential victims of such scams.
To provide an idea regarding the serious nature of various medical fraud issues in America, a number of present and past stats can be referred to, as listed next:
$68 billion is a conservative estimation of how much healthcare frauds cost the US, as per the National Health Care Anti-Fraud Association
That is slightly less than 3% of the United States’ total health care spending (2.26 trillion) on an average.
Source: The Growing Issue of Healthcare Fraud in the US / hillreporter.com
It’s never been a question of tools or technology. It comes down to two drivers. First, there is no institutional will to reduce Medicare of Medicaid fraud, particulary when it is “free money” and States have to repay Uncle Sam 3 out of every 4 dollars they recover.
Second, there is no organized prevention. Pay and chase lives on, and today’s ‘predictive modeling’ (and I use the term loosely) are merely an extension of that old and creaky method.
Prevent fraud and kill the disincentives put into law by lobbyists, and billions will be returned to taxpayers and others who pay for insurance