Medicaid/Medicare Fraud

Abstract Public health care fraud often involves false reports of medical conditions made to health care providers and/or the government. Sometimes this includes fabricating reports relating to patient disease, addiction, accidents, or crime; and sometimes it means fabricating reports to conceal patient neglect and abuse. Fraud schemes range from the simplistic to the complex. False reporting intended to defraud publicly funded health care is widespread and growing. This reflects the size of the health care system's bureaucracy, the lack of oversight and communication in the reimbursement process, and the tremendous amount of money involved. All of these things make public health care an irresistible target. The public perception of health care fraud does not accurately reflect the most representative cases. Most believe fraud originates from individuals abusing state assistance. In reality, cases reflecting the fraud of individual patients involve low dollar amounts. However, cases involving health care providers and suppliers, acting alone or as part of an ad hoc criminal syndicate, can bilk state and federal programs out of millions of dollars. They also evidence the tendency of health care fraud schemes to be not only lucrative and complex, but long term.