Introduction
The legal entity mandated to prosecute cases of medical scam is the Health Care Fraud Unit (HCF), a division from the Fraud section of the Criminal Division. The HCF is made up of a team of prosecutors who focus on cases that comprise significant financial losses from the public treasury and harm to the patient (Ed.gov. 2019). Furthermore, this unit boasts of proficiency and competence in prosecuting fraud cases related to the health care within the U.S. through its Strike Force. But, Miami happens to be the location of the United States’ largest and first Strike Force in Medicare Fraud (Ed.gov. 2019). The Strike Force is exemplary and has recorded remarkable achievement in the prosecution of Medicare-related fraud comprising home health, community mental health, and HIV infusion.
Data for this study was collected due to staggering amounts that are lost annually to Medical scam, thanks to, the strike force that has done excellent work since its initiation in 2007 as it has successfully prosecuted nearly 4000 perpetrators. According to the office of the Inspector General (2019), these individuals, who have contributed to the fraudulent billing of Medicare to sums totaling USD$ 14 billion have all been jailed and others forced to pay restitution. Moreover, in the course of their investigation and consequent prosecution of the villains, the Strike Force indicted nearly 124 offenders from Florida only ( Ed.gov. 2019 ) . The total amounts of money associated with the fraud of these Floridians are estimated at USD$ 337 million. The Strike Force is commendable and has set a fantastic accomplishment in the successful trial of healthcare- linked scam encompassing community mental health, HIV infusion, and home health.
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The Procedure
The data was obtained on the internet by searching for medical fraud in the United States. The search was conducted through Google search engine and then narrowed by using a Boolean search; medical fraud + department of justice + statistical data. The website of the Treasury Department (2019) is rich on the information regarding the misappropriation of the taxpayers’ revenue through the healthcare scandal. With the villains getting smarter by the day as exemplified n the recent back and knee braces scam that was even advertised on T.V., there is need to educate the masses regarding the vast funds that are misappropriated. With the public aware of the practice, it’s easy for them to act as watchdogs and report any cases they witness to the relevant authorities for action to be taken against the culprits.
The Results
Identity theft is one of the common ways in which criminals have used to defraud Medicare and Medicaid of healthcare funds. Based on the statistics from the Bureau of Justice Statistics (2013), in 2012 alone, approximately 16 million United States citizens experienced the theft of their Identity. These figures represent nearly 7% of all U.S. citizens between the age of 16 or older. Out of the 16 million stolen identities, 20% of the identity theft was associated with healthcare fraud. The thieves gain access to the existing accounts through the credit and debit card information and use personal information to initiate new medical claims for services that were not provided.
Further research on the subject matter revealed that the government loses a lot of money through falsified or unnecessary claims by private organizations. The department of health services supports this information and the department of justice (2016), deposited USD 2.6 billion in the fiscal year 2017 with the CMS and the Treasury Department. The money was then dispersed to various federal agencies that offer programs related to healthcare or was paid to private organizations. From the stated figure, approximately USD 1 billion was lost through medical care scam. In general, nearly every 10 cents of each dollar accounted for in healthcare insurance scheme is misappropriated or stolen before it reaches the beneficiaries.
Nurses, physicians, patients, and pharmacists have not been left out of the fraud as they have been caught and prosecuted by the Strike Force. These professionals participate through charging for services never provided, inflating claims, duplicating claim files, falsifying records, or even giving patient information for kickbacks. The Department of Health and Human Services and the Department of Justice (2006) cites that, out of the 600 individuals arrested in 2017, 70 of them were doctors, 30 nurse practitioners, eight licensed medical professionals, and 35 pharmacists. These medical professionals have been a cause for the U.S. government to lose a lot of money that could have benefitted numerous citizens. Hence, their criminal involvement in the medical practice end up endangers the lives of innocent Americans.
Conclusion
The data collected will be significant in the evaluation of the extent of healthcare fraud and its impact on the beneficiaries. Since the fraudulent claims keep increasing annually and the villains have proven to be too smart, the data will be used in analyzing possible ways of assisting law authorities in arresting the culprits. Additionally, the research will try to identify the right tools for the detection of the fraud or the correct measures to be undertaken to prevent the medical scam. The study will form the data evaluation to identify potential policies that can be used to safeguard the benefits of the patient against corrupt individuals. Furthermore, the research paper will be used as a tool to lobby for the policies and sensitizing the citizenry concerning medical fraud and their right to mass action.
References
Bjs.gov. (2013, December 12). Bureau of Justice Statistics Victims of Identity Theft, 2012. Retrieved May 22, 2019, from https://www.bjs.gov/content/pub/press/vit12pr.cfm
Ed.gov. (2019, January 31). Office of Inspector General. Retrieved May 22, 2019, from https://ed.gov/about/offices/list/oig/index.html?src=ft
The Department of Health and Human Services & The Department of Justice, (2006). Health Care Fraud and Abuse Control Program Health Annual Report For F.Y. 2005 -OIG .HHS .gov https://oig.hhs.gov/publications/docs/hcfac/hcfacreport2005.pdf
Treasury.gov. (2017, October 4). About OIG. Retrieved May 22, 2019, from https://www.treasury.gov/about/organizational-structure/ig/Pages/default.aspx
