Healthcare fraud is a serious problem.
Using the IDvw Authenticator™ as a secondary database, healthcare providers can reduce the widespread practice of fraudulent billing with the same card number from multiple locations simultaneously.
Medical claim fraud depletes government funded healthcare, costs tax payers billions and increases private insurance rates.
Private insurance: $40 billion (FBI report for USA non-health related insurance)
Medicare: $310 billion (10-15% fraud of $3 trillion according to NHCAA 2012 report)
“On a national level, fraud hampers our health care system and undermines our nation’s economy. The United States is projected to spend $3.1 trillion dollars on health care in 2014 and generates billions of claims from health care service and product providers every year. Medicare alone accounts for $635 billion in annual spending. On an individual level, no one is left untouched by health care fraud; it is a serious and costly problem that affects every patient and every taxpayer across our nation.”
(Louis Saccoccio, Chief Executive Officer, National Health Care Anti-Fraud Association; “Preventing Medicare Fraud: How Can We Best Protect Seniors and Taxpayers?” Before the United States Senate Special Committee on Aging March 26, 2014)
According to the National Health Care Anti-Fraud Association in the United States in 2014, approximately 10% ($310 billion) is lost in the health care industry each year due to identity theft and fraud; of that, 10% ($7 billion – $23 billion) is attributable to patient fraud.
In the United States, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) established a national Health Care Fraud and Abuse Control Program under the joint direction of the Attorney General and the Secretary of the Department of Health and Human Services to coordinate federal, state and local law enforcement activities with respect to healthcare fraud and abuse.
During the year 2010, the U.S. Federal government won or negotiated approximately $2.5 billion in health care fraud judgments and settlements. In the 14 years of the program, the HCFAC has returned over $18 billion to the Medicare Trust Fund.
In 2014 the United States spent nearly $3.1 trillion on health care. The National Health Care Anti-Fraud Association (NHCAA) estimated that conservatively, 3% of all health care spending or $68 billion is lost to health care fraud. Government and law enforcement agencies placed fraud-related losses much higher; at 10% or $310 billion. $234 billion is roughly equivalent to the Gross Domestic Product of a nation the size of Columbia or Finland.
No segment of the health care industry is immune from fraud. Fraud and abuse can be found in every geographical area of the country.
Medicare and Medicaid fraud cases included questionable activities on the parts of patients as well as medical providers. Estimates are 80% of health care fraud is committed by medical providers (doctors, clinics, pharmaceutical companies, etc.) Examples of fraudulent activity consist of fraudulent billing, kickbacks, up-coding services, performing unnecessary services, over-charging, unbundling and ghost patients.
The balance is perpetrated by others such as the insurance companies themselves and their employers.
Canadian Public Healthcare: $12 billion (CHCAA 2012 report )
Health Care Private Sector: $2.4 billion ( CHCAA 5% fraud rate)
The Canadian Institute for Health Information (CIHI) stated that total spending on health care in Canada was expected to be $191.6 billion in 2011.
The CHCAA (Canadian Health Care Anti-fraud Association 2012) estimates that healthcare fraud is between 2% and 10% of health care dollars ($12 billion). If the same 10% range holds true, consumer fraud could be $1.2 billion.
Annual healthcare spending across the 27 countries of the European Union totals approximately one trillion Euros (approximately $1.35 trillion U.S.) Between 3% and 11% of GDP’s are spent on healthcare in the European Union countries.
It is conservatively estimated that approximately 56 billion Euros (US $75 billion) are lost to fraud each year (European Healthcare Fraud and Corruption Network).
The Europeans have recognized that healthcare fraud and corruption it is too big an economic and social problem to ignore. They want detection systems that will promptly identify occurrences of healthcare fraud and corruption.
“Preventive measurement of healthcare fraud losses allow for better prioritizing of counter fraud actions and more efficient investment of means. Intelligent use of business analytics additionally allows for stopping perpetrators before the fraud has its full devastating effect” (Paul Vincke, President of the European Healthcare Fraud and Corruption Network)