How do fraud and abuse impact the costs of health care?

Healthcare fraud and abuse result in billions of dollars of losses each year for the federal government and private insurance companies. The ultimate cost of those losses is far-reaching, which is why the government is very committed to detecting and prosecuting healthcare fraud.

Healthcare fraud is a crime under federal law, and those who violate the law will face stiff penalties if convicted. Healthcare fraud can also result in civil penalties under federal laws that prohibit making false claims to the government.

A conviction on charges of healthcare fraud can be very damaging to reputation or even career-ending. It can be accompanied by incarceration and hefty fines. The stakes are too high not to get the best possible defense.

how does fraud and abuse impact the costs of healthcare

How does healthcare fraud affect the cost of healthcare?

Healthcare fraud artificially inflates the cost of medical services, which means more money must be paid for claims. More money paid for claims by insurance companies leads to increases in healthcare premiums. More money paid by federal benefit programs means raising taxes and cutting services elsewhere.

For many people and businesses, health insurance is already a significant expense, and raising premiums puts an even greater strain on tight budgets, which may mean benefits will be lost or coverage reduced.

About 160 million people in the United States rely on Medicare or Medicaid for healthcare benefits. Payments made for fraudulent claims take more resources out of the pockets of every taxpayer and may deprive those in need of essential medical services.
The result of healthcare fraud is to cause the cost of healthcare to go up while also contributing to the government’s need to increase taxes.

The far-reaching impact of healthcare fraud

Healthcare fraud creates expensive losses for insurance companies and federal healthcare benefits programs. According to the National Health Care Anti-Fraud Association (NHCAA), of the $3.6 trillion spent on healthcare in the United States in 2018, as much as 10% (over $300 billion) was attributed to healthcare fraud.

Compromised quality of care

But the fallout from healthcare fraud affects more than just the federal government and insurance companies. The health and welfare of patients may be compromised when they receive treatment they do not need or have their medical records falsified or inaccurate. It has been shown that healthcare fraud may also affect the quality of care patients receive from perpetrators.

In a recent study published in JAMA Internal Medicine, researchers compared Medicare claim data from patients treated by known perpetrators of healthcare fraud with data from patients treated by non-perpetrators. The study concluded that Medicare patients who were treated by perpetrators of fraud and abuse during a particular period of time were more likely to die or need emergency hospitalization than patients treated for similar conditions by non-perpetrators.

Loss of trust

Healthcare fraud also erodes the trust between patients and providers of medical care. Patients can no longer be certain a provider’s motivation is to help them get better and not financial gain. Such patients may not respond as well to treatment or be less likely to follow recommendations.

Increased premiums

Healthcare fraud causes insurance companies to raise premiums to offset inflated claims payments. When insurance companies increase premiums, businesses buying healthcare coverage for their employees must then raise their prices to cover increasing costs. Insurance companies may also respond by making coverage more restrictive to try and minimize opportunities for fraud.

Facing accusations of healthcare fraud? A skilled defense is crucial.

Some people may initially see healthcare fraud as almost a victimless crime because the only ones losing money are payers thought to have pretty deep pockets. But in the final analysis, healthcare fraud victimizes everyone, which is why it is no joke to federal prosecutors. Being accused of healthcare fraud is a serious matter that can result in severe penalties if convicted.

A healthcare fraud lawyer with Griffin Durham Tanner & Clarkson LLC understands the priority given to healthcare fraud investigations. Formerly on the prosecution side of federal fraud investigations, our attorneys are uniquely qualified to successfully defend accusations of healthcare fraud. Contact Griffin Durham Tanner & Clarkson LLC at (404) 891-9150 in Atlanta or (912) 867-9140 in Savannah.