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Massive Amount Of Health Care Spending Is Lost To Medical Fraud

This news item at caught my attention for a couple reasons:

"The National Health Care Anti-Fraud Association ( conservatively estimates that 3 percent of all health care spending--about $68 billion--is lost to fraud. A more jaundiced, or perhaps realistic estimate by the FBI and CDC puts the rate at 10 percent, a crippling $226 billion loss yearly. Suddenly the urgency for electronic medical record adoption is in sharp focus because the best way to spot fraud is by using high-tech data mining tools. One company at the forefront of this effort is HealthCare Insight, South Jordan, UT. HCI explained to DOTmed News that medical identity theft is a multi-faceted problem... in a nation of nearly 50 million uninsured the temptation is great for families to misrepresent who is eligible for insurance... So there are perpetrators who add others falsely or give their card to a family member or someone else to get care, and it is still fraud..."

Consumers are not the only ones who commit medical fraud. Companies do it too:

"... all too often the bad actors are not the patients but health care professionals... also on the provider side where billing schemes use a legitimate provider's identification number and name but set up a phony address... Once the scheme is in place, reimbursements can be diverted to the bad guys..."

This article caught my attention for two reasons.

First, whether the accurate fraud statistic is 3% or 10%, either way that represents a massive amount of money, and fraud. And that is bound to attract a lot of identity thieves and fraudsters looking to borrow or steal consumers' medical credentials.

Second, anytime I read about data mining, alarms go off in my mind. Any time a company is analyzing consumers' electrnic medical records, there is the possibility for data breaches; either at the analysis firm or during transmission between health care organizations and the analysis firm. Firms may not want to admit this, but it is what it is.


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What do we expect about our public healthcare system? All I can say is Nothing!! They are only saying that they did major changes but the truth is they are only doing minor changes but the true problem still exist.

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