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Fraud in the Healthcare Industry

Healthcare fraud comes from isolated instances of theft of medical equipment to the actions of entire criminal organizations engaged in stealing patient information. There are many companies that exist only on paper and bill insurance firms that provide fictitious services to patients. Many people working in health care deny the problem of fraud, unwilling to acknowledge the large-scale losses. However, anti-fraud experts say that no steps can be taken to address the issue until the magnitude of the problem is recognized.

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The field of medical services has never been without the attention of fraudsters. Despite the constant struggle against them, criminals are still inventive and come up with new ways to steal money. The Internet is particularly replete with dubious offers of medical assistance (Health IT Security, 2020). There are sites for psychological pieces of training, consultations, and seminars, assistance in obtaining quotas for free surgery, and services of caregivers who disappear after the first few days of caring for a sick relative. Scammers create fake medical certificates, sick lists, and tests and trade in miracle drugs and devices (Health IT Security, 2020). The unifying motives for criminals in this category are the desire to get money quickly and the idea that they can get away with it. The number of sites hiding behind the names of famous media personalities is growing. Therefore, citizens should be extremely careful when referring to those or other services offered on the Internet.

Independent investigations are proving the huge sums of money that healthcare fraudsters can make. According to the National Health Care Fraud Association, outright fraud results in an annual cost to the healthcare industry of at least 3% (Ethan & Welch, 2020). Government and law enforcement agencies put losses as high as 10% of the U.S.’s annual costs, $170 billion a year (Ethan & Welch, 2020). Health care fraud refers to any unlawful gain by providing falsified documents for health care services. The subjects of healthcare fraud can be patients and healthcare providers or the insurance companies themselves (Mackey et al., 2020). Healthcare fraud is regulated by both federal and state laws and has high penalties. The malefactor’s profit from the credulity of citizens, and often their far from selfless help turns out to have grave consequences. And many people are aware of this but still buy and go to get dubious drugs and medical devices.

Today, federal law provides both administrative and criminal penalties for healthcare fraud. Administrative penalties for healthcare fraud include compensation. Criminal penalties for healthcare fraud include imprisonment as well as fines. However, regardless of the level of legislation (federal or state), healthcare fraud charges have serious consequences. Depending on the severity of the harm caused, the length of incarceration varies (Mackey et al., 2020). If the court has imposed a fine, one should be prepared for the amount of the penalty to be extremely high. Along with a fine, the court will often order the defendant to pay compensation to the injured party to compensate for the material damage caused. For example, a healthcare provider may pay the insurance company for material damages for issuing fraudulent checks for services not rendered. In particular, an accusation of healthcare fraud, if brought against a healthcare professional, can have a severe impact on his or her professional career. Even if a healthcare provider appears as a suspect and is later found not guilty of a crime, it will leave a mark on their reputation.


Ethan, L., & Welch M. D. (2020). Quackonomics! The cost of unscientific health care in the U.S….and other fraud found along the way. Page Publishing.

Health IT Security. (2020). Telehealth is the new normal, but so is online fraud. Web.

Mackey, T. K., Miyachi, K., Fung, D., Qian, S., & Short, J. (2020). Combating health care fraud and abuse: Conceptualization and prototyping study of a blockchain antifraud framework. Journal of Medical Internet research, 22(9), 1-65. Web.

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