Costs for health care - prevalence and prosecution of healthcare fraud

In August 2009 the American Medical Association reported that a study shows at the George Washington University Medical Center that will be almost 10 percent of the estimated health care costs $ 2.3 trillion in 2007 - are fraudulent. The problem was, and found a systemic affect both public and private insurers, the service individuals, employers' group policies and public programs.

The most common fraud methods that drive up health careCosts are false statements, wire transfer kickbacks, and the bundling of services incorrectly coded services not delivered. The report attributes 80 percent of health care billing fraud to health care companies, 10 percent of consumers, and the remainder a mix of insurers and their employees.

The incidence of healthcare fraud in the private sector is less well known, and by the public as to what happens in the Medicare and Medicaid programs because the government is obligated to recognizepublish this information.

An example of the blatant fraud in health care described in the report are allegations that a major insurance company manipulated its accounting practices to drive out-of-network physician reimbursement to health care costs by up to 28 percent. The report also revealed large financial settlements made by several pharmaceutical companies and hospitals for fraudulent billing of Medicare and Medicaid programs.

The federal government is taking action toStem cells, systemic fraud in health care. The Ministry of Justice and Health and Human Services who have a common anti-fraud and enforcement of the Committee and to root out fraud Founded in health care.

President Obama also recently signed a new law changes to take advantage of the ability of the government, the False Claims Act to expand pursue fraud in the health care system. In addition, Obama has proposed budget for 2010 on the allocation of $ 311 million - a 50 percent increase over theLast year to beef Medicare and Medicaid, healthcare fraud prevention measures. It is estimated that the reduction of healthcare fraud in these public programs to save the government 2.7 billion U.S. dollars in healthcare spending over five years.

Obama proposed fiscal 2010 budget also calls for the infusion, an additional $ 311 million - a 50% increase compared to 2009 appropriations - to strengthen Medicare and Medicaid anti-fraud programs. The government reported that the cooperation with law enforcement authoritiesProsecution of healthcare fraud back $ 1.1 billion in 2008.

Some of the initiatives that the Department of Justice to take are to reduce fraud in the health sector to:

Specialized training in technology for the investigators.

A careful analysis of the data Centers for Medicare & Medicaid Services.

Provision of training and resources to health care facilities to better prevent and detect fraud and billing errors.

Increased monitoring of Medicare Advantage and prescriptionDrug plans.

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