Part 1 Part 2 of a series
The message is flooded with titles that paint a bleak picture of health in the United States. The politicization of the Affordable Care Act (aka Obamacare) scandal veteran of the business, and now new reports in the quality of their health care system of the United States ranked last when compared to 10 other countries, the Western industrialized countries, it is clear that the United States in the center of a national health crisis.
One of the factors behind the crisis is fraud. While fraud today makes a small part of the institutional question, it was dirty little secret in the world of medicine for years, and getting worse.
Health spending in the U.S. totaled $ 2700000000000 (which is 17 percent of GDP), with nearly $ 1 trillion will be the cost for Medicare and fraud and the rules and annual inspections to combat Medicaid. There are no current estimates of how much is diverted, and despite some sharp probes 2000, the industry remains an easy target for criminals.
Last month, the police, the arrest of 90 people (including 16 doctors and nurses) in the amount of Medicare fraud billed separately announced the program jointly funded by the taxpayers approximately $ 260 million fraudulent charges. Healthcare fraud is so common in the U.S., in some cases, doctors, pharmacies and patients conspire together, making it more difficult to identify scams.
For example, older patients receive discounts when they sell your contact information to a pharmacist, who then offer generic drugs while billing Medicare for more expensive brands. Clinics often "pill mills" where a "prophet of doom", wrote prescriptions for drugs that are then sold on the street. In New York, the clinic was recently accused of fraudulently generate orders of more than five million tablets of oxycodone, which were sold on the spot $ 30 - $ 90 each.
In 2011, two dozen people, including three doctors, owners of assisted living and distributors in Florida were related to various health fraud, bribery and money laundering for his alleged involvement in a fraud charged $ 205 million billing Medicare for mental health cases.
After the verdict, U.S. Attorney Wifredo A. Ferrer, said: "The health has come fraud to all levels of the health sector, the owners and managers of dirty clinics, doctors complicit, program directors, therapists, patients and recruiters permeate."
Fraud is unpredictable. Moves, developed changes. Criminal activities in the health sector are becoming more demanding and complex time. Detect organized criminal groups; has also been reported that Medicare investigators found weapons caches during arrests.
Health fraud is so lucrative, in fact, that some cocaine dealers have changed prescription fraud because there is less risk and high reward being. In particular, patient identity theft was more profitable than stealing credit card, this information for orders of controlled substances may be used.
As a private patient information continues its way database workbooks, federal regulations have ACA and HIPAA final rule health organizations required to make significant progress to ensure the privacy and security policies meet to better protect patient data.
However, during the ACA has contributed to the introduction of stricter auditing in order to avoid fraudulent billing, the law actually increases the risk for patients with replacement of the uncertainty, databases and various websites record, according to a Ponemon Institute report.
Time for large organizations and agencies to take over and coordinate the new rules and procedures required and cybercriminals have begun to take place, the benefits of the difficult position of catcher, so that the coordination methods of cyber attacks, the complex networks include people, accounts and events, to complete their scams.
Agencies and organizations that have already received many tips that can investigate further. Manual Audit Bureau of thousands of records are intensive, error-prone, and take too long. Adding to the confusion, in addition to Medicare and Medicaid recipients turn administered at private systems if federal investigators have less access to these data, which leads to fewer recoveries in relation to fraud. And with the proliferation of networked medical devices, cloud computing services, storage of medical records online and mobile applications, fraud investigations, due to the large amount of data to sift through complex.
Healthcare fraud has entered a new digital frontier. Criminal organizations are more professional, better organized and technologically than ever before. As a result, the public and private sectors are looking for reactive measures, huge amounts of data that the fraud earlier crunch, track trends, and finally, or before it happens.
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Next week we have our two-part report on health care fraud in the United States still turned to the enormous and growing impact of cyber crime on businesses and government organizations, and what is being done to stop it.