medical fraud image​In June of this year, the Department of Health and Human Services Office of Inspector General, along with state and federal law enforcement partners, participated in an unprecedented nationwide health care fraud takedown. According to the 2017 National Health Care Fraud Takedown fact sheet, “More than 400 defendants in 41 federal districts were charged for their alleged participation in schemes involving more than $1.3 billion in false billings to vital health care programs. Of those subjects charged, 115 are medical professionals—particularly doctors and nurses. Thirty Medicaid Fraud Control Units participated in the takedown.”

The task force and the resulting arrests underscore the scope of health care fraud and how individuals, including lawyers, medical professionals and others, participate in the fraud rings and pass on their fraud techniques to others. As criminals learn from each other and develop new techniques to commit fraud, so too should the health care industry, borrowing ideas from the financial services industry, for example, to reduce fraud and increase program integrity and, more importantly, patient safety.

Reduce Fraud, Waste and False Claims: Fighting Health Care Fraud with MIDASTM

Unlike other industries, fraud in health care can lead to physical harm. For example, patient safety is threatened by criminals who steal someone’s medical identity to obtain drugs such as opioids. The resulting polluted medical record can result in a delay in treatment or worse for the victim of medical identity theft.

Like the financial services industry, leading executives are implementing medical identity alerts to engage the consumer as the first line of defense against medical identity theft and fraud. By doing so, they can identify standalone transactions that are questionable and use crowd sourced input, from thousands of individuals, to identify new rings and fraud patterns. The individual can play a huge role in identifying and reducing fraud – it’s time health care look to this critical resource to increase patient safety and complement other investments made in analysts, analytics, and predictive algorithms to deter fraudulent transactions and payments before they are made.