Complex Health Care Fraud

Due to an increase in managed care plans in Medicaid and Medicare there has been a rise in complex health care frauds according to a Wall Street Journal Report. The article examined how new kinds of fraud is being committed as the private sector is providing more Medicare and Medicaid services.

These frauds are more difficult to notice, more complicated as well as difficult to prosecute and can cause more harm to patients. This has prompted the federal government to increase scrutiny. In the 1990’s both states and the federal government began shifting Medicaid and Medicare beneficiaries to managed care plans.

The reason for this move was to control costs and reduce fraud. However the number of health fraud investigators was reduced as well. Traditionally fraud prevention involved policing doctors, hospitals, dialysis centers etc. This was meant to catch overcharges or fraudulent billing.

Regulators are now realizing that they need to get more attuned to complex scams carried out by sophisticated corporations.