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War on Health Care Fraud Continues, but is Proving Difficult

Over the past few years, the Obama administration has put a great deal of focus on combating all types of health care fraud, especially in relation to the Affordable Care Act. In fact, around $600 million a year is being spent on investigating and preventing incidents of health care fraud. However, despite all of the effort being put into fraud investigations, there is still a long way to go in putting an end to this crime in the United States.

Part of the problem is the method that the government is using to combat health care fraud in itself. The outside contractors used in these investigations, for example, are more likely to be influenced by politics and other conflicts of interest. Government officials and other contractors have admitted as much. The responsibilities given to these contractors can be unclear. Private insurance companies are responsible for their own enforcement, which means it’s harder for the government to uncover evidence of fraud that happens within those companies.

To give an idea of just how rampant a problem health care fraud is: approximately $60 billion of Medicare’s annual costs, or about 10 percent, is allocated to fraud and systematic overcharging. The Centers for Medicare and Medicaid only has the capacity to manually review about three million of the approximately 1.2 billion claims it receives every year, which makes it much easier to be successful in fraudulent activities.

To those who are aware of these statistics and issues, it can seem that the federal government is fighting an uphill battle against health care fraud. However, results have been trickling in, and those being convicted of health care fraud are facing significant punishments.

Any doctors or health care providers who face health care fraud charges or who have been defrauded should contact a trusted New Jersey health care fraud attorney with Buttaci Leardi & Werner, LLC right away.

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  • Posted on: Sep 25 2014