Health Care Fraud and the Impact on White Collar Crime

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Health care fraud is a major concern for the United States. National healthcare spending is already an astounding $2.7 trillion dollars but it will only continue to rise since health care fraud costs the country approximately $80 billion dollars a year, as reported by the Federal Bureau of Investigation (“FBI”). As the economy fluctuates, more health care professionals are willing to risk patient harm and their practices to achieve these health care schemes, and so the total loss in health care continues to increase. The Centers for Medicare and Medicaid Services estimate that by the year 2016, health care spending will exceed $4.14 trillion. The FBI is one of the main government agencies that investigates health care fraud against federal and private insurance programs. The U.S. Office of the Inspector General (“OIG”) also conducts nationwide investigations, audits and inspections to protect the U.S. Department of Health and Human Services’ Federal health care programs, such as Medicare and Medicaid, against health care fraud. Centers for Medicare & Medicaid Services, Medicare Fraud & Abuse: Prevention, Detection, and Reporting, (November 2012), http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Fraud_and_Abuse.pdf. Individuals who have committed health care fraud may be prosecuted criminally and be imposed a fine or sentenced to prison or both. Individuals may also be sued in civil actions, by the Government and by private individuals, for committing health care fraud. Civil penalties include the repayment of damage or exclusion from participation in Federal health care programs. Health care fraud comes in many forms including: knowingly billing for services not rendered, knowingly billing for supplies not provided, knowingly altering claims forms to receive a higher payment, billing for services that are not

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