Fighting the Battle against Health Care Fraud

By Serota, Scott P. | Chief Executive (U.S.), June 2005 | Go to article overview

Fighting the Battle against Health Care Fraud


Serota, Scott P., Chief Executive (U.S.)


CEO VIGILANCE CAN HELP ENSURE BETTER CARE FOR ALL. BY SCOTT P. SEROTA

Health care fraud is a dangerous and expensive crime. The national cost tops $85 billion a year and is a burden borne by all of us -employers, workers and tax payers-in the form of higher health insurance premiums, out-of-pocket costs and tax dollars. Moreover, every dollar stolen by a con artist is a dollar not available for emergency services, life-saving treatments, drugs, medical research and other vital health care services.

Fraud is not only a crime. It also is a major clanger to the health and safety of consumers and undermines the public trust in the medical community.

As business leaders, we must aggressively advance fraud awareness and prevention efforts within our own companies and, as responsible corporate citizens, with the broader public and the communities we serve.

Fraud takes on many forms, but the menace of health care fraud is exemplified in the most egregious way by the so-called "Rent-a-Patient" scam that has received widespread media attention.

This scheme allegedly involved paid recruiters who enlisted "patients" to travel to southern California surgical centers and undergo unnecessary and sometimes risky invasive surgery. In return, providers participating in the scam allegedly promised them cash payments and submitted millions of dollars in fraudulent and grossly inflated bogus insurance claims. It is believed to be the first major scam in which clinics and surgeons paid healthy patients to undergo such procedures.

While virtually every insurer in the country has been affected by the widespread scam, members of the Blue Cross and Blue Shield Association decided to take aggressive action. In March, 12 Blue Plans filed a $30 million civil suit in response.

Can the actions of business, government and individuals really make a difference? According to a study by Taxpayers Against Fraud, they can. The group found that every dollar invested by the government in False Claims Act investigations and prosecutions returns $13 to the American people. The report, compiled by the Economic and Social Research Institute, showed that from 1999 to 2003, the government spent $409. …

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