Healthcare fraud is, according to one legal definition, a crime in which healthcare claims are dishonestly filed to profit illegally from the payments received. It is estimated that it leads to a loss of nearly $60 billion per year.
There are many types of healthcare fraud, including those carried out by healthcare practitioners and those committed by healthcare insurance members. Prosecutions under this title are carried out under the federal False Claims Act.
Why does healthcare fraud matter? With this type of fraud, the customers of the healthcare organization are made to pay for the money robbed. Some legal experts estimate that a tenth of each dollar spent on health care is wasted on such fraudulent claims. In addition, healthcare fraud can mean patients undergo unnecessary tests, evaluations, treatments, and procedures.
Moreover, health insurance premiums may go up because of the heavy claims paid out, while overall, taxes may be raised to pay for the health insurance claims. Many of these have come to light due to private whistle-blowers, as well as investigations by independent researchers to identify the causes of increasing healthcare costs.
Healthcare fraud is a matter involving the violation of trust between healthcare providers/managers and patients using deception to gain an illegal financial advantage at the cost of the patient. The various elements include:
A front-page article with the byline of veteran New York Times opinion writer Nicholas Kristof is the latest poisonous example of what I call the NGO “halo effect.” Headlined “The Silence That Mee...