Healthcare Fraud Overview

Healthcare in the United States in 2005 cost approximately $1.8 trillion every year.  It is estimated that as much as $90 billion of that amount was lost to healthcare fraud.  Healthcare fraud translates to higher health insurance premiums, higher taxes, and higher co-payments. 

Patients have been harmed as a result of fraudulent activities involving medical transportation, surgeries, invasive testing, and certain drug therapies.  (For example, a pharmacist was convicted for diluting cancer drugs purely to increase profits; and surgeons performing unnecessary surgery to increase profits).  Patients and their insurance information are being exploited in ways that are new and sometimes harmful.

Healthcare Fraud is a federal crime, as well as, a crime under most State criminal codes.  State legislators continue to enhance their regulatory oversight to address areas vulnerable to fraud and abuse.  Some states require health insurers to meet certain fraud-related preparedness standards and thousands of dishonest and un-credentialed providers have lost their medical license to practice.