July 11, 2011
Health care fraud and abuse is an important and conspicuous factor in the resource and finance drain in the US healthcare system and is responsible, to an extent, for the escalating healthcare costs.
According to a report by Thomson Reuters on US healthcare spending, the US healthcare system wastes between $505 billion and $850 billion every year, out of which the waste caused due to Fraud and abuse constitutes $200 billion, or 22% of healthcare waste every year.
The following chart shows the percentage of waste caused due to different parameters in the US healthcare spending.
Source: Healthcare analytics, Thomson Reuters
What is healthcare fraud and abuse?
Health care fraud is a criminal act in which a consumer or physician(s) deliberately misrepresents facts or information, for the purpose of undeserved or greater reimbursement. Health care abuse is a reckless disregard or conduct that goes against and is inconsistent with acceptable business and/or medical practices resulting in greater reimbursement.
How to prevent it?
Health care fraud and abuse has played such a vital role in increasing the cost of health care and has become a pertinent issue for the government as well as the general public. The question is how to prevent it?
Both Consumers and physicians have to be alert to the possibility of fraud and abuse and work to prevent it. Consumers need to get involved with their health care beyond the point of going to the doctor and taking medication. They need to be educated on their insurance plan, how much they pay, the proper names of their ailments, and they need to keep track of the services they receive and why they receive them. Simple tips that may help prevent fraud and abuse include:
• Review Explanation of Benefits to ensure accurate dates of service, name of providers, and types of services reported
• Protect insurance card and personal information at all times
• Count pills each time they pick up a prescription
• Research providers with state's medical boards
• Report suspected fraud and abuse as soon as possible
Along with consumers, physicians too must check for any unintentional fraud and abuse happening around them. They can have training and awareness amongst their staff to prevent unintentional fraud. These joint efforts would definitely check the fraud and abuse rate in the United States and ultimately bring down the overall cost of healthcare.
EMR / EHR / Health IT