A historical analysis of federal policies on health care fraud.

摘要

Health care fraud is an illegal act; it is a white-collar crime. Providers of health care services commit it to get more money. Fraud occurs when a health care provider "knowingly and willfully" lies about health care equipment and services that supplied or provided. Unlike errors of business transactions, it does not result from an honest billing mistake.;The federal government's inauguration of Medicare and Medicaid programs in 1965 introduced a new corporate fraud among the providers of health care services. Health care fraud presents economic, social, and political problems and costs American taxpayers billions of dollars every year. Eradication of fraud from the health care system constitutes a daunting task for public policymakers. The Federal Bureau of Investigation (FBI) estimates that fraud consumes between 3 and 10 percent of the nation's health care expenditure. The problem is so prevalent that the U.S. Senate has invested efforts to confront the alarming situation. Health care fraud results in a loss of public funds and reduction in required services for the beneficiaries and drives up the cost of health care services.;Eliminating fraudulent activities from the federal health care programs is a challenge to the government. However, some government agencies are assisting in the control of the social and economic bane of the American health care system. Although fraud in federal health care programs is less likely to go away, it is noteworthy to asseverate that the federal government, through stringent policy measures, is taking drastic actions to curb the prevalence of fraud and abuse in the federal health care programs. The Federal Government utilizes two categories of laws and policies to address health care fraud. The laws are the "traditional generic" fraud statutes and the laws Congress enacted to address specific issues involving health care fraud. The False Claims Amendments Act of 1986 is the main weapon the Federal Government uses to combat fraud, and the statute has considerably aided government's efforts in the recovery of funds from individuals and entities engaged in fraud against the government health care programs. While more still needs to be done, there is no gainsaying that the government is achieving positive results in the war on health care fraud through the use of the several laws Congress has enacted to address the problem.