Kelly Kennedy a reporter for USA Today recently wrote a story about healthcare fraud and abuse, and shared a staggering statistic, according to government statistics “federal health care fraud prosecution in the first eight months of 2011 are on pace to rise 85% over last year”

To read the full article please click here

Examples of Healthcare Fraud

Here are some examples of healthcare fraud presented in bullet points:

  • Billing for services not rendered
  • Phantom billing (billing for fictitious patients or services)
  • Upcoding (billing for a more expensive service than provided)
  • Kickbacks and bribery in exchange for patient referrals
  • Unbundling (billing separately for bundled services to increase reimbursement)
  • False cost reports to inflate reimbursement

Which Specialties Are Most Susceptible To This Dangerous Trend?

Certain healthcare specialties are particularly susceptible to the rising trend of fraud. Specialties such as pain management, durable medical equipment, and home healthcare are frequently targeted. Understanding the vulnerabilities in these fields is crucial for preventing and combating healthcare fraud effectively. Stay informed to protect the integrity of healthcare practices.

What’s Contributing To Healthcare Fraud?

What is causing this dramatic increase?  The Obama administrations ramped up fraud enforcement and economic recoupment efforts which are being banked on as a way to pay for Obamas proposed Health Care Reform plans.

According to the article, statistics which were harvested and released by the Transactional Records Access Clearinghouse (TRAC) show that prosecutions went from 731 people in 2010 to 903 people so far in 2011.  Furthermore “prosecutions have gone up 71% from five years ago, according to TRAC.”

USA Today Fraud Statistics

USA Today predicts Fraud Prosecutions to Rise

With such an emphasis on recoupment from both a fraud and abuse perspective, and a RAC audit perspective it will become more important than ever that organizations are aware of all of the new laws and regulations which are being released, and that they have a healthcare compliance program in place to mitigate any risk to their organization.

The key is preparation… make sure that your organization is ready.  If you are not sure if you have a solid healthcare compliance program, BHM can help.  Just give us a call at 1-888-831-1171 to set up your free initial consultation.