The National Health Care Anti-Fraud Association (NHCAA) estimates that 3% of all healthcare spending – about $68 billion – is lost to fraud each year in the United States. The FBI / CDC estimate that figure could be as high as 10%, or $226 billion.
In the past, we’ve talked a great deal about the impact that fraud has on businesses and on consumers, including those affected by medical fraud. But we have yet to talk about the cost – the billions of dollars – this fraud is costing all of us in other ways.
Whether you have employer-sponsored health insurance or you purchase your own insurance policy, health care fraud inevitably translates into higher premiums and out-of-pocket expenses for consumers, as well as reduced benefits or coverage. For employers—private and government alike—health care fraud increases the cost of providing insurance benefits to employees and, in turn, increases the overall cost of doing business.
The NHCAA estimated in 2007 that $2.26 trillion was spent on health care and the 4 billion health insurance claims processed in the US. They conservatively estimated that $68 billion of this was lost to fraud, quite an astounding figure. The majority of health care fraud was found to be committed by a small number of dishonest health care providers submitting false claims to insurers and to public programs.
This abuse of claims can have damaging effects on patients who may find themselves victims of medical identity theft, with their insurance benefits affected by misuse. In addition to providers, organized criminal groups and individuals also perpetrate health care fraud. The report includes examples of crime rings that shifted from illegal drug trafficking to medical fraud schemes, resulting in millions of dollars in fraud.