Based on the tone and substance of a recent speech and press release from Eric Holder, the federal government plans to step up investigations and prosecutions of medical professionals for health care fraud. Mr. Holder made it clear that the government considers health care fraud one of the country’s “most destructive” and “widespread” challenges. As a result, the federal government has created a couple of task forces specifically conceived to deal with health care fraud cases. Mr. Holder is also asking state and local law enforcement agencies to assist the federal government in making health care fraud cases and make their own cases.
Health care fraud, also referred to as Medicare or Medicaid fraud, can take several forms. Some of the more common accusations of health care fraud involve claims that doctors are charging the government for medical services or equipment that were not necessary or doctors are charging the government for medical services or equipment that were not provided. Investigators will look for what they consider to be excessive or unusual billing practices when investigating health care fraud cases.
According to the government, approximately $60 billion in public and private health care spending is lost each year to health care fraud. As a result, the government is increasing its budget to fight what they perceive to be health care fraud. In 2010, the federal government increased the health care fraud budget from $200 million to $300 million. As expected, health care fraud cases have increased. In the six months prior to the speech and press release, 60 health care fraud cases were filed and over 200 people were charged with health care fraud related crimes.
When the government focuses on a particular issue, they will pump more money into enforcement and increase arrests and prosecutions. Often times, the wide net cast by the government to make these cases crosses the line between illegal fraud and honest mistakes and aggressive but legal business practices.