Health care fraud is one of the darker sides of US health care and administration, with billions of dollars lost each year in questionable payments, a product of our fractured health care system.
Health care fraud is able to proliferate at far larger levels in the US due to a combination of private and public payers, and a lack of communication between involved parties to highlight health care fraud when it occurs.
While health care fraud exists in countries with single payer systems, widely believed to be the most efficient and cost-effective way to deliver medicine in all countries except the United States, our system of multiple insurance providers coupled with government payers like Medicare and Medicaid as well as state-level payers makes communication between agencies and organizations quite difficult.
But the government has turned an eye to health care fraud as the debate about health care spending continues unabated — and this week announced an initiative to more closely monitor health care fraud instances and potentially recoup some of the funds lost to the practices.
Health and Human Services Secretary Kathleen Sebelius spoke about the new initiative at a White House event hosting many insurance executives. Sebelius said:
“Lots of the fraudsters have used our fragmented health care system to their advantage… By sharing information across payers, we can bring this potentially fraudulent activity to light so it can be stopped.” State investigators are also part of the effort.”
Dr. Richard Migliori is an executive vice president of UnitedHealth Group, and he commented on how the initiative benefits insurers:
“What’s in it for us is that if you have more data, you are going to be able to recognize aberrant patterns more reliably… These perpetrators are moving around from one place to another. You are going to have more eyes on them and they are going to feel surrounded.”
For Medicare alone, a system that serves a small portion of the population, health care fraud is estimated to cost $60 billion each year.