In the world of healthcare fraud, there is a lot more going on than just one person filing a false claim for reimbursement. In fact, it is a very complex issue that has far-reaching effects on everyone within the industry. Ileana Hernandez of Manatt, Phelps & Phillips recently pointed this out during an interview.
Hernandez said that she has seen a lot of confusion among patients about how they are affected by healthcare fraud. “People don’t know how it affects the cost of insurance premiums,” she explained. “But it has to do with the overall costs of healthcare because all this fraud contributes to insurance companies having to charge more for their premiums. So then consumers are picking up the tab through increased premiums.”
She added that there is also a lot of confusion about how much money is being lost due to healthcare fraud. “While people think that it is a massive problem, they have no idea how massive it really is,” she said.
Hernandez also pointed out that healthcare fraud costs a lot of money, but it can even cost a person’s life if the person in question decides to pay for a healthcare service with a fraudulent insurance claim.
This can happen when a person ends up in the hospital, and the hospital ends up with unpaid costs because of a false claim, Hernandez said. “Then they have to recoup money somehow, so they may try to cut corners on care,” she added. This could result in an individual not receiving the proper care.
“It is a hidden cost, but it can have genuine consequences,” said Hernandez. “Hospitals will often be left with no choice other than to cut back on staff and other important resources because of unpaid costs associated with healthcare fraud. But, of course, this means that patients will receive less care.”
What then are some things that consumers can do to ensure that this doesn’t happen to them? “The key is for insurers, providers, and consumers to work together to stamp out healthcare fraud,” said Hernandez. “Insurers must be more proactive in screening claims for potential fraud, and providers need to be more careful about the claims they file. Then consumers must be diligent as well and avoid filing a claim for services that were not received.”
For those who have been victims of healthcare fraud, Hernandez recommends working with their insurance company or Medicare or Medicaid if they receive benefits from one of these programs. “Then they should also contact a lawyer to figure out how to proceed.”
According to Hernandez, the healthcare industry is involved in an ongoing war against healthcare fraud, and it must continue this battle if there is any hope of winning. “It has been estimated that about 10 percent of all medical expenses in America go towards fraudulent claims. That is a staggering amount of money!” she said. “One study even noted that if the healthcare industry can successfully reduce fraud by just 1 percent, it could save as much as $30 billion each year.”
Hernandez added that the only way to win such a battle is through cooperation and transparency among all those involved. “We all need to heed the call, and we must also be willing to work together to put an end to healthcare fraud.”