Tag: insurance statements

Insurance Fraud, Abuse and Waste Could Be Reduced With High Deductible Policies

There is huge amount of money expended in the American health care delivery system – 17% of the GDP. Some of it is diverted through fraud, some is garnered via abuses and a lot is due to waste.

Fraud, abuse and waste are words used by politicians frequently. How much of each is there? Are there straight forward ways to reduce them? Among the best approaches is to enlist the patient as the first line of defense – with high deductible policies.

Not surprisingly fraud is relatively common in healthcare given the huge amount of dollars involved. As Willie Sutton once said when asked why he robbed banks – “That’s were the money is.” A Dallas-area physician stands accused of systematically defrauding Medicare of $350 million largely by excessive or grossly inappropriate referrals to home health agencies. Given all of the rules and regulations, how is it possible that such a gigantic fraud could be perpetrated over a five year period with no one noticing until recently?

The extent of medical fraud is uncertain. Commercial insurers estimate about $60 billion and Medicare/Medicaid estimates about $72 billion or more per year. In 2010 the US government was able to reclaim about $4 billion and convict more than 700 individuals of Medicare fraud and abuse.

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