The healthcare industry needs a reliable compliance system more than ever. Healthcare Fraud is rearing its ugly head hundreds of times more than any other criminal conviction. In the 2014 OIG report on the Medical Fraud Control Unit, ¾ of the criminal convictions are all about health care fraud and abuse.

 

Healthcare Fraud has become the top criminal conviction in OIG analysis charts, with as many as 993 cases in FY 2013 alone. Last year’s report yielded 956 cases of fraud! What makes these figures even more alarming is that they have been consistent for the past five years.

 

How and why is this becoming a trend in the healthcare industry? What are its implications?

 

Let’s take a closer look at the types of cases that make health care fraud a criminal conviction: physicians improperly prescribing drugs or billing for services that weren’t rendered. Grand larceny. Accepting kickbacks. Conspiracy to commit health care and abuse by several parties. Falsifying statements regarding health care matters.

 

The stakes are high for those behind this crime: tens of billions of dollars in Medicaid and Medicare funds are lost to fraud every year. An emerging trend shows how organized crime groups are taking part in sophisticated health care fraud schemes. This misdirection of funds threaten the health and safety of millions of people, with false billing and diagnoses altering their medical history, or making them suddenly ineligible for certain coverage and benefits.

 

To have any form of criminal activity when health is at stake is simply unacceptable and a cause for alarm. Apart from the financial and legal repercussions, these cases paint an ugly picture of the physician/health care professional as a white collar criminal. It also presents an unfair scenario for honest health care professionals: to have their reputation and years of experience and hard work tarnished by those taking advantage of the health care system.