Health care fraud or health insurance fraud is not like violent crime. It doesn’t leave someone traumatized and doesn’t damage property. Some people think of it as a form of victimless crime, but that simply isn’t the truth.
Every individual and business that pays taxes contributes to Medicaid and Medicare funds. When a health care provider or a member of their staff intentionally engages in fraudulent billing practices, the taxpaying public is ultimately the victim because their funds are what pay for those fraudulent claims.
Understanding the scope of health care fraud and its impact on tax-funded insurance programs can help you understand the real risks of improper insurance billing practices.
The government understands the impact of provider fraud
Often, when pundits and journalists talk about insurance fraud, the focus is on the individual receiving benefits. However, government statistics make it clear that provider fraud is a much bigger concern.
Provider fraud is a major concern, with the Centers for Medicare & Medicaid Services estimating just under $43 billion in improper Medicare payments and more than $86 billion in improper Medicaid payments in 2020 alone. Although some of those amounts will represent recipients who should not have received coverage, much of that money goes out to medical facilities billing for the wrong procedure or even for visits that never occurred.
While it is impossible for the government to scrutinize every individual claim, there are professionals whose entire jobs revolve around validating and investigating billing claims submitted to government insurance programs. They can and do find evidence of providers misusing programs for financial gain. When they do, criminal investigations often lead to charges.
With health care fraud, the risk isn’t just about money
It takes many years to complete the necessary education to work in the medical field and only a few mistakes to cost you your job and possibly your license. Upgrading charges, fabricating appointments or even unbundling charges could help you earn a little more money, but it could also put you and the people who work for you at risk.
Learning more about the most common forms of health care fraud and other white-collar crimes can help you avoid unintentionally breaking the law.