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Focus on health care fraud: Is the spotlight accurately placed?

Federal regulators and enforcement agencies have targeted various types of fraud for major investigative probes in recent years, especially in the wake of the so-called Great Recession.

Many of our readers in Florida and elsewhere will likely remember the seemingly non-stop onslaught of media articles that commenced a few years back chronicling episodes of mortgage fraud, various types of lending improprieties, fraudulent securities-related activities (including, centrally, insider trading) and other illegalities.

One especially prominent focus of government investigators in recent years has been health care fraud, especially fraudulent activity that targets the national Medicare and Medicaid programs.

Has that been a valid concern and focal point of investigative efforts by law enforcement agencies and prosecutors?

By most measuring sticks, it has been. In fact, one national anti-fraud association notes in an article on health care fraud that financial losses owing to illegal schemes in this realm "are in the tens of billions of dollars each year."

Given the sheer magnitude of the government's Medicare and Medicaid programs, compellingly strong scrutiny has been focused on actors both alleged and proven to be guilty of illegal activities that siphon off taxpayer-funded monies for these initiatives.

Much of that exacting focus has been on doctors and other health care professionals across the country, given the central roles that they play in the administration of health care.

Is that focus fairly applied? In other words, do media portrayals of criminal wrongdoers in the medical industry accurately present facts and data regarding the number of persons who commit health care fraud against the government? Are many outstanding and consummately professional medical practitioners being unfairly appraised by being tarnished through their association with a very small group of bad actors?

The above-cited article states that, "The majority of health care fraud is committed by a very small minority of dishonest health care providers."

Undoubtedly, that is true, with it being further evident that many fraudulent acts being committed in the industry are authored by individuals and groups who are not even associated with medical care providers.

We will continue with that theme in our next blog post.

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Focus on health care fraud: Is the spotlight accurately placed? | Frank A. Rubino, Esq.