Health care fraud is a persisting problem that affects the whole nation. Billions and billions of dollars are lost every year because of health care fraud and abuse, resulting in increased health care costs and increased costs for health care coverage.
Health care fraud is the intentional misrepresentation, deception, or act of deceit for the purpose of receiving greater reimbursement for services or coverage for services. Health care abuse, on the other hand, is reckless disregard or conduct that violates acceptable medical business practices.
Health care fraud and abuse can take many forms. These include using an insurance card that does not belong to you, adding an ineligible person to a contract, or failing to remove someone from the contract when no longer eligible. The most common instances of provider fraud are billing for services not provided, duplicate claims, upcoding, misrepresenting the services provided, or kickbacks.
The FBI estimates that the health care fraud cases cost American tax payers $80 billion a year. Of this amount, $2.5 billion was recovered via the False Claims Act in FY 2010. Over the course of FY 2010, whistleblowers were paid a total of $307,620,401.00 for their part in bringing the cases forward.
You can help prevent health care fraud and abuse by reviewing your Explanation of Benefits to ensure accurate dates of service, names of providers, and types of services reported. You should protect your insurance card and personal information at all times. If you suspect fraud and abuse, report it as soon as possible!