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Health Insurance Fraud and Its Impact on Healthcare Systems

Health Insurance Fraud and Its Impact on Healthcare Systems

Health Insurance Fraud and Its Impact on Healthcare Systems

Fraud and abuse have plagued our healthcare systems for many years.  In fact, the Department of Justice reported a $1.4 billion loss from health care fraud schemes in this year alone. So it is no wonder why there have been several crackdowns on fraud initiated by both the state and federal governments.

Whether it is intentional or not, healthcare frauds have serious implications on all of us. It is not just healthcare service providers or violators facing consequences, it also affects people who rely on federal healthcare programs like Medicare and Medicaid.

Health Insurance Fraud and Its Impact on Healthcare Systems

Healthcare fraud stresses and puts too much pressure on our healthcare system, which in turn diminishes the quality of the healthcare services that we receive. Some even linked fraud and see it as one of the primary reasons why we have to pay higher premiums as well as receive unnecessary or risky services that we do not even need in the first place.  

Therefore, it is everyone’s responsibility to self-report or report any healthcare fraud. Apart from it being a great public service, reporting fraud to the authorities would also help mitigate and prevent these adverse impacts in our healthcare systems.

Overwhelming our Healthcare System

The last thing that every doctor or any healthcare service provider should worry about is a lawsuit. Our healthcare system can function more efficiently and effectively if health practitioners only focus on the health of their patients. With a pending violation or lawsuit hanging about, their undivided attention can compromise their work as well as the healthcare service that the patient receives.

As a doctor usually says, “prevention is better than cure.” So in order to not overburden our healthcare system, we must do our best to prevent these frauds from ever occurring.

If you are a healthcare professional or healthcare service provider, one of the best ways to avoid unintentional violation is to be familiar with the laws related to our healthcare system. This way, you would be able to determine what practices are prohibited and then overcorrect those practices as soon as possible.

Otherwise, or if you are a witness or a patient who happens to be a victim of fraud, then your best option is to file a report to your local authorities or get assistance from a healthcare fraud lawyer. It is worth noting that whistleblowers can even get monetary rewards once they successfully report healthcare fraud.

Another reason why healthcare fraud occurs is due to the lack of an effective standardized patient identifier. Fraudsters, when committing these acts, have information on the patients from a number of sources, and can easily pass verification as there’s no effective patient identifier. However, many healthcare providers are preventing medical identity theft via accurate patient identification with RightPatient. It is a touchless biometric patient identification platform that identifies patients using their photos, and since patients’ faces are used for verification, fraudsters are red-flagged easily – preventing healthcare fraud. 

Detrimental to Patients’ Health

Healthcare fraud can come in many forms. It is not just manipulating medical bills or upcoding, it can also be ordering too many tests or recommending unnecessary treatments to patients. These types of fraudulent and abusive activities are detrimental to the health of the patients because doctors can misdiagnose a disease and some illnesses can even resurface due to unnecessary treatments.

Other types of fraud that are also detrimental to the health of patients are medical record errors, false statements, and unqualified medical recommendations. Take the case of the patients in Maryland who paid to get treated but still died because their X-rays were not reviewed properly by a qualified radiologist. It is a perfect illustration of how money and lives were lost due to fraudulent activities.

Unfortunately, the example above is just some of the many examples of fraud that are happening across the country. That being the case, it is then up to us to be on the lookout for these abusive activities; and as much as possible, try to prevent these unfortunate cases from ever happening.

Higher Premiums

If you rely on health insurance to foot your sudden emergency medical bill, then you probably already know how monthly premiums work and how it can sometimes leave a hole in your pocket. But, did you also know that fraud is one of the deciding factors that determine how much your monthly premiums should be?

According to the Department of Justice, monetary losses due to healthcare fraud are offset by higher premiums, increased taxes, and reduced services. Oftentimes, the largest recoveries are due to fictitious or false claims. The DOJ has pursued and recovered thousands to billions of dollars due to violation of the False Claims Act.

Cases like these affect our healthcare systems and increase our monthly premiums because as the cost of healthcare rises, so will the cost associated with these fraudulent activities. As a result, patients would then have to shoulder these out-of-pocket expenses and rising insurance premiums.

With all that said, healthcare insurance fraud trickles down and affects our entire healthcare system. No matter if it is intentional or not, it is apparent that these fraudulent activities are harmful to everyone. So we must assume responsibilities in safeguarding our healthcare system and make sure that these fraudulent activities would not go unpunished. This way, we would not overburden our healthcare professionals and patients would receive the proper medical care they are rightfully entitled to. 

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