Healthcare fraud in the US is more common than one would think. In fact, the US government loses billions of dollars each year due to fraudulent billing, kickbacks, and other illegal activities by physicians, hospitals, pharmaceutical companies, and many other stakeholders. In my opinion, the fines for healthcare fraud should be stiff, especially in cases that result in unnecessary injuries or deaths.
In my estimation, one of the best things that can be done to improve healthcare, and minimize incidents of fraud is to eliminate the profit motive from the healthcare system. In a video about Health Management Associates (HMA) that was aired on 60 Minutes, it was alleged that HMA used quotas to admit patients (Kroft, 2012). Moreover, doctors who admitted patients were pressured by senior management into reaching “admissions goals”. These goals help the hospital make profits. Whereas no one has complained about the quality of care at HMA, many people complained about the “quantity of care” (Kroft, 2012). According to an FBI agent, this practice amounted to Medicare fraud (Kroft, 2012). However, after his reports, he was conveniently “transferred” and “fired” by HMA, despite his reports of Medicare fraud (Kroft, 2012). Clearly, there was suspicious activity on behalf of HMA. Later, the Justice Department was assigned to investigate the allegations of fraud.
Doubtless, fraud is rampant in today’s healthcare system. The objective of capitalism is to make a profit. Thus, it seems hypocritical to ask the healthcare system to operate without a profit motive. There is a lot of pressure to make money (Massey, 2013). Thus, it is fairly evident that broader societal changes must take place, in order to ensure that patients receive adequate medical care which does not bilk the government, i.e. the taxpayers, in the process. In other words, we desperately need a different kind of monetary system. Unfortunately, nearly all of the healthcare providers who defend their overbilling of the government are obviously deceitful.
Barring any major systemic changes in the monetary system, it is clear that executives of large healthcare companies should be punished with jail time and/or stiff monetary fines. Moreover, government agencies who pay the bills, such as Medicare, should be more proactive in the oversight of potentially-illegal activities. There should be more rigorous processing of claims to Medicare. In addition, healthcare companies, especially pharmaceuticals, should not be allowed to lobby politicians. Then, the question becomes: who will police the police? The healthcare system is broken, and the only ones who profit from it are its stakeholders. Unfortunately, patients are not considered stakeholders. Perhaps, regular people should co-operatively own and operate healthcare providers, to some degree.
While the situation seems grim, there is some hope. For example, a medical doctor, Okon Umana, who also served as the medical director of a Brooklyn medical clinic, was found guilty of Medicare fraud, and sentenced to two years in prison (Morse, 2015). In addition, the Department of Justice ordered him and his co-conspirators to pay more than $6 million in restitution, and give back $6.5 million to the government (Morse, 2015). This kind of prosecution is a good start, and sets an example for how the US government will deal with misconduct on the part of healthcare professionals. Furthermore, since 2007, the Medicare Fraud Strike Force, operating in nine cities, has already recovered more than $7 billion from 2,300 defendants who bilked Medicare. Thus, stringent punishments are helping improve the quality of the healthcare system, and saving money for taxpayers.
References
Kroft, Steve. (2012, Dec. 2). Hospitals: the cost of admission. 60 Minutes. Retrieved from
https://www.youtube.com/watch?v=iEXkKV3kbb8
Massey, Johnnie (Presenter). (2013, Sep. 4). Audio Educator: Health Care Fraud and Abuse
(what is it?). Podcast retrieved from https://www.youtube.com/watch?v=MrAfgLQlvd
Morse, S. (17 Aug. 2015). Brooklyn doctors gets two years in prison for $13 billion billing fraud.
HealthcareFinance. Retrieved from
http://www.healthcarefinancenews.com/news/brooklyn-doctor-gest-two-years-prison-13-
million-billing-fraud
