Friday, July 16, 2004
Unnecessary open-heart surgery? Fraud eats up health care dollars
[Vanessa Maltin, "Fraud plagues U.S. health care," The Atlanta Journal-Constitution, 13 July 2004.]
Medical fraud adds an unnecessary burden to a system that is in many respects overwhelmed. In any situation where fraud occurs, it is important to investigate not only the individual incidents but the incentives that allow such behavior to become attractive:
An estimated $85 billion was lost to health insurance fraud last year, the Blue Cross and Blue Shield Association said Tuesday.
That figure is 5 percent of the $1.7 trillion spent on health care nationwide in 2003, officials said at a news conference marking National Fraud Awareness Week.
A symptom of the increasing problem is that physicians are now willing to put patients at risk, said Tim Delaney of the FBI's health care fraud unit. He cited a California case in which a cardiologist performed open-heart surgeries on patients who did not need them.
Among the most common types of health care fraud were improperly prescribing drugs, performing unnecessary medical procedures, billing for services never provided, masquerading as health care professionals and billing for a more expensive service than the one performed.
"Every dollar stolen from the health care delivery system by fraud perpetrators is a dollar not available for necessary life-saving treatments, drugs, research or emergency services," said Byron Hollis, anti-fraud director for the trade association of the independent Blue Cross and Blue Shield insurance plans.
To combat the trend of increasing fraud, Blue Cross and Blue Shield, which insure more than 88 million people, recently created an anti-fraud strike force to coordinate efforts among the 41 companies in the system. Last year, Blue Cross and Blue Shield reported recovering $240 million from fraudulent claims, a 52 percent increase from 2002.
Blue Cross and Blue Shield says that patients can help combat fraud by double-checking bills and telling their insurance provider of suspicious items.
[Vanessa Maltin, "Fraud plagues U.S. health care," The Atlanta Journal-Constitution, 13 July 2004.]
Medical fraud adds an unnecessary burden to a system that is in many respects overwhelmed. In any situation where fraud occurs, it is important to investigate not only the individual incidents but the incentives that allow such behavior to become attractive:
An estimated $85 billion was lost to health insurance fraud last year, the Blue Cross and Blue Shield Association said Tuesday.
That figure is 5 percent of the $1.7 trillion spent on health care nationwide in 2003, officials said at a news conference marking National Fraud Awareness Week.
A symptom of the increasing problem is that physicians are now willing to put patients at risk, said Tim Delaney of the FBI's health care fraud unit. He cited a California case in which a cardiologist performed open-heart surgeries on patients who did not need them.
Among the most common types of health care fraud were improperly prescribing drugs, performing unnecessary medical procedures, billing for services never provided, masquerading as health care professionals and billing for a more expensive service than the one performed.
"Every dollar stolen from the health care delivery system by fraud perpetrators is a dollar not available for necessary life-saving treatments, drugs, research or emergency services," said Byron Hollis, anti-fraud director for the trade association of the independent Blue Cross and Blue Shield insurance plans.
To combat the trend of increasing fraud, Blue Cross and Blue Shield, which insure more than 88 million people, recently created an anti-fraud strike force to coordinate efforts among the 41 companies in the system. Last year, Blue Cross and Blue Shield reported recovering $240 million from fraudulent claims, a 52 percent increase from 2002.
Blue Cross and Blue Shield says that patients can help combat fraud by double-checking bills and telling their insurance provider of suspicious items.
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