It’s no secret that most Americans pay a lot for nearly any kind of medical care, but a close look at factors that are driving higher health care prices in the US reveals more about why medical care is so expensive these days. One element that you may not think about is health care fraud and how it impacts you.
The Cost of Fraud
Reports from health care experts show that Americans may be paying up to $80 billion per year because of health care fraud. That’s out of 2 trillion dollars spent annually, including a federal Medicare program that is estimated to be worth about $450 billion, with 44 million beneficiaries on the books.
Government entitlement programs contribute quite a bit to the problem – not necessarily because of the programs themselves but because of the abuse by disreputable providers. Because of the unique reimbursement rules for these programs, many dishonest providers are able to simply bill Medicare and another government entitlement program, Medicaid, for services and goods that were never actually provided to patients.
What is the Government’s Response?
Even though the government has been prosecuting more medical companies and practices, and has recovered over $10 billion for Medicare since 2009, it continues to be a huge problem. With all of the loopholes and opportunities for fraud in the current system, this issue is not going away anytime soon. As the federal government and state governments scramble to identify health care fraud and convict fraudulent operators, it’s important that consumers get involved in the struggle as well. More details here.
What Can You Do to Protect Yourself?
One action under your control is to carefully read and review your medical bills. It’s important that you know what services your medical bills are representing and why each item costs as much as it does. Surveys have found that one in five patients doesn’t understand the descriptions of procedures on a medical bill, and many never question these kinds of charges. As a result, health care fraud remains rampant.
Always take the time to go over the details listed and call providers if anything on your bill is less than clear. Don’t settle for a non-itemized bill: demand that providers show in clear terms what charges represent and why they were billed. This kind of vigilance not only helps your financial bottom line, but it also protects the community at large from a greater threat of systematic health care fraud.
Having grown up in a family with 5 physicians of different specialties, one of the happier aspects of my job as a compliance officer is working together with health care providers to find simple solutions, whether it be for front desk processes or documentation, that keep them from inadvertently slipping onto the wrong end of the regulatory process. There is usually a “light bulb moment” in each of these conversations when a satisfactory conclusion is reached and where peace of mind is achieved.
While health care fraud has more subtlety than the mentally prehistoric toss of a rock through a window, it is no less an act of theft. Going forward, with a major national health care overhaul on the horizon, it particularly falls on those of us in the medical reimbursement field to give the best guidance possible to the providers we service to assist them in avoiding the sinkholes along the regulatory highway.
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