We hear so much about "insurance fraud'' and "over-billing'' these days. Our fragile economy and the government's stepped-up efforts to educate the public about this widespread problem, have created an unprecedented buzz not only in the media, but also in our physicians' waiting rooms.
We are very pleased to see that the federal government, under the leadership of President Barack Obama, U.S. Health and Human Services Secretary Kathleen Sebelius and U.S. Attorney General Eric Holder, is aggressively pursuing the crooks who are defrauding American taxpayers of an estimated $60 billion a year.
Just last month Holder announced what he called "the largest federal Medicare fraud take-down in history.'' In Miami and four other U.S. cities, 94 people were arrested and charged with submitting $252 million in fraudulent claims. All told, that brings to about 800 the number of people and businesses that have been charged with ripping off the American people to the tune of $1.8 billion in false Medicare claims since 2007.
Holder said he is sending a message to the Medicare cheaters that "if you steal ... you will go to jail."
Good for him. But the public needs to know that even though this is an unprecedented effort by the federal government to root out Medicare fraud, it is only the tip of the iceberg. This has been more than two years in the making, and it is a good start. But the strike force needs continued funding to enforce the law and increase public awareness about the problem.
It's about time this topic received the attention it is due, and that is one of the reasons we began this blog. Medicare fraud, as well as the waste of healthcare resources and the abuse of patients, are problems that have been overlooked and under-reported for a very long time.
We all know that the criminals - in our neighborhoods and in our board rooms - should be reined in. But how do we accomplish that?
Reporting and enforcing fraud and abuse are obvious answers to that question. But before we, as consumers, can be motivated to expose wrongdoing, it is essential that we know why it is wrong, and how it negatively affects our lives.
First, it is useful to understand the difference between fraud and abuse. After all, you can't report if you can't see it.
It is fraud when a person or an organization intentionally deceives or misrepresents the insurer in order to obtain an unauthorized benefit. Submitting a bill for services that were not rendered is a good example of fraud. Abuse involves charging for services that are not medically necessary or are overpriced.
Make no mistake: Fraud and abuse affect the lives of innocent people every day. And we all pay the price - not just Medicare clients. It wastes our tax dollars. It causes our healthcare costs and insurance premiums to increase. And it endangers our lives when we are given unnecessary tests or treatments.
Now that you have a better understanding of the bottom-line relevance of this widespread problem, we urge you to do your part by reporting, to us or to law enforcement authorities, any suspected cases of fraud, waste or abuse. Our goal is to bring these criminals to justice, and to create a more honest, more affordable, and more efficient climate for healthcare.
