Monday, September 11, 2023

Our Multi-Billion Dollar Medical Fraud Problem

The Multi-Billion Dollar Medical Fraud Problem in the United States

We have a multi-billion dollar medical fraud problem in the U.S. and it's costing Americans somewhere between $68 billion and $300 billion each year according to the experts. That means that fraudsters and charlatans are pilfering from our healthcare system the equivalent of between $200 and $900 a year, every year, from every man, woman, and child in the United States.  Of course, Americans who use healthcare services infrequently probably aren't even aware of what's happening.  They can rest assured, however, that medical fraud is costing them in the form of higher health insurance premiums, increased tax burdens, and added out-of-pocket costs when they do have to use healthcare services.  And if financial harm for patients and taxpayers isn't bad enough, medical fraud can also expose Americans to personal harm from medically unnecessary tests, procedures, or medications.

The most common type of medical fraud involves providing tests, procedures, or medications that are not medically necessary. Other common types of medical fraud include (1) billing for services that were not rendered, (2) billing for a more expensive service than the one actually performed (a practice known as "upcoding"), (3) kickbacks payments made to doctors or other healthcare providers in exchange for referring patients or ordering certain tests or procedures, and (4) submitting claims with fraudulent information to a healthcare payer.

Medical fraud is a complex problem for the U.S. healthcare system and there are ongoing public and private initiatives to combat it. Such efforts include:

  • Enhanced oversight and enforcement by government agencies
  • Better education and training for healthcare providers
  • Improved data analytics to identify patterns of fraud
  • Whistleblower programs that reward individuals who report fraud

If you suspect medical fraud, do not hesitate to report it to the U.S. Department of Justice or your state's attorney general's office. You can also report it using the resources available from the National Health Care Anti-Fraud Association (NHCAA).


(1) The Challenge of Health Care Fraud: by the National Health Care Anti-Fraud Association
(2) Health Care Fraud | United States Sentencing Commission
(3) Inside the mind of criminals: How to brazenly steal $100 billion from Medicare and Medicaid
(4) Health Care Fraud - FBI

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