U.S. attorney cracks down on health care fraud

Health care fraud results in higher insurance premiums.

Health care fraud is one of the most difficult challenges in lowering health care costs–not only does the practice rob from the sick, elderly or infirm, it also translates into higher premiums and out-of-pocket expenses for consumers. 

Last week, a Detroit owner of a chemotherapy practice pleased guilty for milking the government in an eight-figure fraud case, and a Los Angeles ambulance company admitted to charging for millions of dollars worth of unnecessary trips. Unfortunately, there are undoubtedly others right now operating similar businesses.

That is why U.S. Attorney David Hickton recently announced his plan for a significant health care fraud probe with a team of four assistant U.S. attorneys and support from the FBI. The Pittsburgh Post-Gazette reported that the Department of Health and Human Services Office of the Inspector General will also be involved.

"Health care funding is supposed to be spent on making people better. It's not supposed to go to fraudsters," Hickton told the Post-Gazette last week.  "This is not about taking the resources of the federal government and going after small ball fraud. This is a huge commitment of resources to something that I feel very strongly about."

The source explains that the probe will be focused on Medicare and Medicaid fraud, but it will also be on the lookout for billings for unwarranted narcotics and "upcoding," a practice where services are misreported to receive larger payouts. 

Fraud can rise premiums and deductibles for subscribers, which can cause significant problems, especially when many Americans currently are enrolled in high-deductible plans. This creates challenges for health insurance claims management professionals, as many patients are unable to cover their cost of their treatment. 

Often, for facilities that are currently experiencing these issues, the decision to outsource receivable management can lead to improved cash flow and fewer dollars written off to bad debt.