Avoid Being the Victim of Healthcare Fraud

by Frank Florio | January 2020
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Health care fraud doesn’t merely impact the entities defrauded but has a ripple effect on innocent consumers as well. “The National Health Care Anti-Fraud Association (NHCAA) estimates that the financial losses due to health care fraud are in the tens of billions of dollars annually.¹ This financial burden is shifted to the consumer, resulting in increased premiums, additional, out-of-pocket expenses, and reduced benefits or coverage.²

A common health care fraud scheme involves theft of personal insurance information to obtain reimbursement for goods or services that were never provided. Scammers have multiple means to acquire this personal information. Fraudsters may provide money, gifts, or other inducements to lure victims to a medical clinics or other location in order to obtain personal information when the victim simply sign in. This information can also be acquired during supposed free screenings, often at health fairs. Fraudsters often pay medical personnel to illegally share private patient insurance information or purchase the data from other criminals who illegally acquired such data.³

Health care fraud isn’t limited to individual fraudulent predators seeking to steal personal health information. There also are wide scale fraudulent health care conspiracies . Recently, twelve retired NFL players were accused of launching an eighteen-month, $3.4 million scheme that involved bringing fraudulent health care claims to defraud the league’s retiree health care benefits plan.⁴ According to news reports about the indictments, the players submitted phony claims for expensive medical equipment ranging from $40,000 to $50,000 each by relying on fabricated invoices, prescriptions and letters of medical necessity.⁵ “In addition, some defendants recruited other retired players to participate in the scheme in exchange for kickbacks and bribes that ranged from a few thousand dollars to $10,000 or more per claim, prosecutors said.” ⁶

Health care fraudsters can range from the every day person, to the rich and famous. So, what steps can you take to protect yourself? First, do not provide any of your personal health care or medical information without first verifying that it is for a legitimate purpose. That information includes insurance cards, the name of your primary care physician, and medical records. Second, be on the alert for gifts or money in exchange for providing your medical information, and report any such suspicious activity. Lastly, always be on the alert at medical facilities. Observe who is around you, verify that anyone asking you personal medical questions is part of the staff, and always safeguard your personal documents.

Receiving health services and care should be a safe endeavor. Unfortunately, fraudsters prey on the most vulnerable. Stay alert, health care fraud is everywhere.

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¹ National Health Care Anti-Fraud Association, The Challenge of Health Care Fraud, https://www.nhcaa.org/resources/health-care-anti-fraud-resources/the-challenge-of-health-care-fraud.aspx
² Id.
³ Federal Bureau of Investigation, What We Investigate, Health Care Fraud, https://www.fbi.gov/investigate/white-collar-crime/health-care-fraud. See, e.g., United States
⁴ Levnson, Eric, Kupperman, Tammy, Maritn, Jill, CNN, Clinton Portis is among 12 retired NFL players accused of health benefits scam worth over $3 million, Dec. 12, 2019, https://www.cnn.com/2019/12/12/us/nfl-health-care-fraud/index.html
⁵ Id.
⁶ Id.