It’s easy to see how healthcare fraud can cost taxpayers and governments billions of dollars every year. And while that is not something to be ignored, healthcare fraud also significantly impacts vulnerable populations like the elderly, those with severe illnesses and disabilities, and those on fixed incomes.

When organizations take advantage of these individuals to make a profit, the American taxpayers end up footing the bill for their illegal activities. Let’s look at how healthcare fraud impacts these vulnerable populations, why shedding light on fraud is so important, and what you can do if you suspect healthcare fraud in your organization.

How does fraud impact quality of care?

When providers, medical coders, and insurance plans only care about increasing their paychecks through fraudulent activity, they aren’t putting the patient’s best interest first. Whether managed care fraud in the Medicare and Medicaid systems or more specialized like respiratory fraud or pharmaceutical fraud, patients receive misinformation and a lack of quality care.

These circumstances are most true regarding healthcare sectors like managed care, where insureds live on fixed incomes and limited resources. Some common healthcare fraud tactics include upcoding, double billing, and phantom billing, which all involve patients and insurance providers being charged for services they don’t need or for services they never even received.

These schemes may leave patients “exploited and subjected to unnecessary or unsafe medical procedures,” keeping these vulnerable populations from receiving the care they need.

Why is Shedding a Light On Fraud So Important

Not only does fraud cost taxpayers and governments significant sums of money, it can significantly impact an individual’s livelihood. When providers don’t give patients the best care possible or aren’t using their insurance funds appropriately, patients may have a more challenging time getting the care they need when and if needed.

For example, in 2022, the Department of Justice announced “charges against 36 defendants in 13 federal districts across the United States for more than $1.2 billion in alleged fraudulent telemedicine, cardiovascular and cancer genetic testing, and durable medical equipment (DME) schemes.”.

In this case, some defendants allegedly controlled a telemarketing network that lured thousands of elderly and disabled patients into a criminal scheme. The telemarketing organizations allegedly used deceptive techniques to “induce Medicare beneficiaries to agree to cardiovascular genetic testing and other genetic testing and equipment” that wasn’t medically necessary.

When telemedicine companies arrange for medical professionals to order these expensive genetic tests and durable medical equipment regardless of whether the patients need them, not only are the telemedicine companies pocketing from false claims, but the patients involved suffer from poor quality of care. For example, in many of these cases, test results or durable medical equipment were allegedly charged to patients’ insurance but were never provided to the patients or couldn’t be used by their primary care doctors.

Help Fight for Justice and Put an End to Fraud

If you suspect fraud in your organization, please contact us. Blowing the whistle on healthcare fraud is a courageous act. When you come forward, you help expose fraud for the greater good, preserving our humanity and safeguarding the systems in place to serve our nation’s citizens who are often the most vulnerable regarding healthcare.

Our DJO Whistleblower Law Group team consists of highly experienced whistleblower experts, lawyers, and even former whistleblowers, who strive to deliver the highest monetary reward for brave individuals with valuable information that can bring fraud to light.

If a whistleblower’s lawsuit is successful, the reward can be up to 25% of the funds recovered. The False Claims Act also offers whistleblowers protection against job retaliation.

DJO will be there every step of the way to ensure you are safe and your information is confidential, so you will have confidence knowing you’re doing the right thing. If you have valuable information that can help expose fraud, we encourage you to speak to our experts today.

Latest Articles