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Healthcare Insurance Fraud reaches all time high.

Posted Jul 19 2013 12:50pm

Surprising figures in Healthcare and Health Insurance Fraud. Who are the victims? Patients, Healthcare workers, the insurance companies and the government. Here are some interesting facts:




The Obama Administration announced recovery of over $5.6 billion in fraudulent payments in fiscal year 2011, a 167 percent increase from 2008.
One of the most powerful new fraud prevention tools is the new authority to suspend Medicare payments to providers or suppliers while investigating a credible allegation of fraud.
In its Annual Report to Congress, the Department of Health & Human Services (HHS) and Office of Inspector General (OIG) announced recent successes in the fight against fraud, waste, and abuse. OIG reported savings of $19.8 billion for fiscal year (FY) 2011.

The federal government announced the following actions for FY 2011:
  • OIG reported exclusions of 2,662 individuals and entities from participation in Federal health care programs;
  • 382 convictions of health care fraud;
  • 723 criminal actions against individuals or entities that engaged in crimes against departmental programs;
  • More than 1,100 new health care fraud investigations with more than 2,000 potential defendants;
  • More than 1,700 pending investigations;
  • $4.6 billion in investigative receivables; and
  • $627.8 million in audit receivables.

FCA Principal Causes of Action include:
  • Any person who knowingly submits a false or fraudulent claim for reimbursement to any U.S. employee for payment or approval;
  • Any person who knowingly makes or uses a false record or statement to obtain payment or approval of a false or fraudulent claim paid by the U.S.
  • Any person who conspires with another to get a false or fraudulent claim paid by the U.S.
  • Any person who knowingly makes or uses a false statement to conceal, avoid or decrease an obligation to pay or transmit money or property to the U.S.

Penalties for FCA violations include civil penalties for each claim of not less than $5,500 and not more than $11,000, plus three times the amount of damages sustained by the federal government. Help stop fraud. Should you suspect, report to your insurance company and or OIG.
Source: EmCare news release.
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