Based on the news we often read or hear on TV, it’s no question that fraud and abuse have plagued every government program these days. But alarmingly, it has become too noticeable that the healthcare sector has been taking the largest hit out of all the other programs.
Despite the federal and state governments’ efforts to curb all these illegal activities, fraud in the healthcare industry still makes up a big slice of settlements recovered by the Department of Justice. In fact, out of the $2.2 billion collected by DOJ in 2020, $1.8 billion came from False Claim Act cases in the healthcare industry.
So now more than ever, it’s time to highlight and discuss why fraud prevention is important in the healthcare industry.
Prevent misallocation of funds
Fraudulent cases like false claims can immediately backfire and set the whole system a few weeks or even years back.
Take the case of a doctor who over bills and claims that a consultation lasts for more than 30 minutes when in fact it’s just a quick 5 to 10-minute check-up. Cases like these not only misallocates and waste funds, but also adds pressure to the system
Less fraud, fewer backlogs
One of the most apparent, and sometimes under the radar, types of healthcare fraud is upcoding. This often has a negative impact not just on the healthcare service provider but also on the patient or the one who receives the healthcare service.
Upcoding can sometimes overstretch a simple medical procedure, which then often results in overbilling and the patient not receiving the proper care he/she truly needs.
Impedes progress and improvement
Anyone working for the government or even your local healthcare fraud attorney can tell you that Medicare or Medicaid fraud has a ripple effect in our entire healthcare system.
Rather than exhausting all our funds and resources to better improve our healthcare system, all efforts and resources are just being redirected to prevent crooks, criminals, and abusers who defraud government healthcare programs.