Healthcare Fraud

Scams and frauds that involve the health care industry are one of the primary focuses of the FBI units that investigate white collar crimes. For this reason, the FBI has established branch offices throughout the nation that are responsible for scrutinizing the policies and practices of healthcare related organizations that are located in their local communities. These organizations include local health clinics, pharmacies, cosmetic surgery offices and medical equipment retailers.

There are many types of frauds the FBI probes, but the top three areas of of healthcare fraud include over-billing, putting patients through unnecessary tests or surgeries and scams related to the pharmaceutical industry.

Fraudulent invoices

Invoice fraud is perhaps the most common abuse within the healthcare system. Patients may be charged for services that were never provided or billed at rates that are much higher than what they should be. Another scam involves charging patients multiple times for the same service. Anyone who receives an invoice for medical services should thoroughly examine the bill to make sure they are not being over charged, and ask questions if the rate appears to be significantly higher than it should.

Unwarranted services

A disturbing trend in modern medicinal practice is advising patients to pursue treatments that are not necessary. These treatments may include surgeries that are not essential to the health of the patient, unnecessary prescriptions and excessive amounts of physical therapy. In some instances, these extra services can actually be harmful to the patients. Individuals who feel that their physician is recommending or prescribing medical procedures or pharmaceuticals that they do not need should seek the advice of another doctor or healthcare professional.

Pharmaceutical scams

Most cases of fraud involving the pharmaceutical industry occur when online pharmacies work together with unscrupulous physicians to convince patients to purchase drugs that are not necessary. These prescriptions are sometimes illegal, and can even be harmful to those that take them. Patients should only obtain their prescriptions at valid pharmaceutical locations.

FBI partnerships

The FBI does not work alone to monitor and patrol crimes within the healthcare industry. They work with the Food and Drug Administration (FDA), Drug Enforcement Agency (DEA), U.S. Department of Health and Human Services-Office of Inspector General (HHS-OIG) and several other national and local government and law enforcement agencies to help put a stop to healthcare fraud schemes. Their overall goal is to wipe out corruption and abuse within the medical industry.

One of the findings the FBI has made while investigating healthcare fraud is that it is often linked to organized crime groups. They will continue to pursue, shut down and dismantle these groups and any others that are found to be responsible for criminal activities.

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