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Healthcare Fraud Overview

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sm-doctorAlmost 80% of all False Claims Act (FCA) cases involve healthcare fraud, primarily related to the false claims submitted to Medicare/Medicaid for reimbursement, causing these government healthcare programs to lose an estimated $60 billion annually to fraud!

Healthcare fraud is a crime that involves the deliberate filing of dishonest health care claims to the government for reimbursement with the intent of generating a profit. Fraud in the healthcare industry is both rampant and considerable. Overall, experts estimate that approximately 10% of all healthcare spending results from fraudulent claims, resulting in higher health insurance premiums and out-of-pocket expenses for consumers.

The federal and state governments collectively spend HUNDREDS OF BILLIONS of dollars every year on physician visits, prescription drugs, hospital care, medical devices, outpatient services and nursing home care through Medicare, Medicaid and other government healthcare programs. Through these programs, the Government trustingly relies on private healthcare providers and hospitals to accurately bill the government for reimbursement after treating patients. Unfortunately, some companies and individuals take advantage of the limited oversight and enormous number of claims to be processed and scheme to submit false and fraudulent requests for payment, gambling that they can generate extra income and remain undetected.

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