Medical Fraud
There are three things in the world that deserve no mercy, hypocrisy, fraud, and tyranny - Frederick William Robertson
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Medical Fraud Carries A Staggering Price Tag
The human cost is high. People who get care when they don't need it face the risks and discomfort associated with medical procedures. And whatever the financial cost, it's translated into higher insurance premiums, as insurers raise premiums to make back the lost dollars. And it's translated into higher tax rates to refill the coffers of the government's Medicare and Medicaid programs that have been drained by fraudulent claims.
Resources
The Medicare disadvantage
How private insurers are gaming the Medicare system and committing fraud. Medicare Advantage, the private-sector arm for elderly care, is fast becoming the new battlefront in the fight against health care fraud in the U.S. Here’s why, and what fraud examiners think should be done.
Are Your Medications Safe?
The FDA buries evidence of fraud in medical trials. My students and I dug it up.
Bob McCoy Warns of Quackery
In the age of quick fixes and assembly line cosmetic surgeries, Bob McCoy urges us to beware of the quack: the doctor who may very well not be a doctor, and who purports to have a cure for just about anything.
Fraud and deceit in medical research
Publication of medical research is the cornerstone for the propagation and dissemination of medical knowledge, culminating in significant effects on the health of the world's population. However, instances of individuals and institutions subverting the ethos of honesty and integrity on which medical research is built in order to advance personal ambitions have been well documented.
Health Insurers Make It Easy for Scammers to Steal Millions. Who Pays? You.
Health insurers are regarded as fierce defenders of health care dollars. But the case of David Williams shows one reason America’s health care costs continue to rise. The personal trainer spent years posing as a doctor and billing the nation’s top insurers, making off with millions.
How Often Do Scientists Commit Fraud?
The evidence says scientists are pretty honest. New techniques could make it easier for scientific fabricators to be caught.
How to avoid getting ripped off by the dentist
There are plenty of excellent, trustworthy dentists out there who make their patients' interests their top priority. But there are also some unethical dentists who provide unnecessary treatments and products simply for profit.
How to Spot a Wellness Scam
An expert shares tips for assessing health information.
Medicare fraud by providers is rampant and government bulk-billing figures are a ‘lie’, review finds
Illegal billing by doctors and other health providers is rampant, with as few as three-in-10 patients being properly bulk billed despite federal government claims that rates are close to 90%, the first comprehensive review of Medicare claiming and compliance has found.
Nursing Homes Defrauded Taxpayers of $83 Million, Lawsuit Says
The nursing homes illegally misused Medicare and Medicaid funds for personal enrichment and neglected patients, according to the New York attorney general, Letitia James.
Scientific Misconduct Should Be a Crime
It’s as bad as fraud or theft, only potentially more dangerous.
Senators call for closing “loopholes” that make health care fraud easy
Following a detailed account of how scam artists can easily gain access to health care cash, six Democratic senators this week sent a letter to federal regulators urging them to “close loopholes” that allow “bad actors” to commit fraud.
Someone could steal your medical records and bill you for their care
It's a double whammy. Unlike other forms of identity fraud, medical identity thieves may steal not only their victims' personal data — Social Security number, date of birth, address — but also information about their medical records and care, potentially putting their health at risk.
Telemedicine fraud ripe during COVID-19 pandemic
Telemedicine isn’t a new concept. It’s become an integral element of health care delivery. However, it’s prone to fraud opportunities because of the absence of direct patient contact. U.S. federal loosening of regulations during the pandemic has opened the door for more telemedicine visits and potential for fraud.
The Challenge of Health Care Fraud
The majority of health care fraud is committed by a small number of dishonest health care providers, and in some particularly distressing cases, by individuals only posing as legitimate health care providers. Sadly, the actions of these deceitful few ultimately serve to sully the reputation of perhaps the most trusted and respected members of our society—our doctors.
The Great Big Medicare Rip-Off
The government is leaving billions of dollars on the table. Here’s how to fix it.
The Theranos controversy, explained
Everything you need to know about the super-secret, controversial blood testing company.
There is a worrying amount of fraud in medical research
And a worrying unwillingness to do anything about it.
Time to assume that health research is fraudulent until proven otherwise?
Health research is based on trust. Health professionals and journal editors reading the results of a clinical trial assume that the trial happened and that the results were honestly reported. But about 20% of the time, said Ben Mol, professor of obstetrics and gynaecology at Monash Health, they would be wrong.
What can be done right now to stop a basic source of health care fraud
There are simple fixes that would make it more difficult for scammers to operate.
‘The Cash Monster Was Insatiable’: How Insurers Exploited Medicare for Billions
By next year, half of Medicare beneficiaries will have a private Medicare Advantage plan. Most large insurers in the program have been accused in court of fraud.
Medical Fraud Carries A Staggering Price Tag
Medical fraud takes several forms. Most commonly, criminals get a list of patients' names, then create fictitious doctors. They send bills to Medicare or Medicaid or health insurers for services supposedly rendered to these patients. By the time the payers figure out that the doctors they're paying are fictitious and no service was ever rendered, the criminals have closed up shop and moved on.
Healthlock
Never overpay for healthcare again. Over half of medical bills contain errors. HealthLock automatically checks for fraud and overbilling—and helps get your money back.
National Health Care Anti-Fraud Association
Founded in 1985 by several private health insurers and federal and state government officials, the National Health Care Anti-Fraud Association is the leading national organization focused exclusively on the fight against health care fraud. We are a private-public partnership
Fraud Magazine
Publication of the Association of Certified Fraud Examiners (ACFE).
The True Face of Medicare Fraud
A $712 million bust, the biggest in U.S. history, shows that the people most likely to bilk the system are doctors and medical providers, not “welfare queens.”
