Health Care Fraud to be Targeted, Fraud Specialists in Demand
The Obama administration is launching its biggest plan yet to combat health care fraud. The U.S. Department of Health and Human Services (HHS) and U.S. Department of Justice (DOJ) recently announced the creation of a new high-level task force with the aim of detecting and preventing health-care fraud, which costs the U.S. billions of dollars every year. Meanwhile, research from the World Privacy Forum shows that medical identity theft has become deeply entrenched in the health care system, and reported cases continue to rise.
In today’s economic climate corporations, organizations or governments can not look at security (including physical security as well as IT or data security) as something that will be implemented after something has transpired, according to one corporate security expert consulted for this article. Rather, they must be keenly aware of what is out there to protect their people and their assets– especially during times of economic turmoil. Facing the growing threat of fraud and its costly consequences, executive search firm, A.E. Feldman, reports that corporations are increasingly looking to corporate security experts for fraud identification and prevention. The recruiting firm is already addressing this growing need and is currently working with the industry’s leading fraud specialists.
Targeting Health Care Fraud
Both the HHS and DOJ have committed senior officials to work together on the Health Care Fraud Prevention and Enforcement Action Team (HEAT). The HEAT Team is charged with the task of expanding efforts to prevent and combat fraud. These efforts include helping state Medicaid officials conduct provider audits and monitor activities to detect fraudulent activities. The Team will also use modern technology to complete more timely analysis of electronic evidence.
Attorney General Eric H. Holder Jr. and HHS Secretary Kathleen Sebelius also directed federal investigators and prosecutors to continue to utilize Strike Force teams focusing on Miami and L.A. as well as create such teams in Detroit and Houston, where billing data suggests high levels of health care fraud, waste and abuse.
“When individuals and corporations cross the line, we will hold them accountable,” said Holder at a news conference in Washington. Sebelius added, “What we’re talking about today is theft, plain and simple.”
The announcement comes on the heels of an ominous prediction from the trustees who monitor Medicare’s finances that the trust fund that pays hospital bills for elderly patients will be depleted by 2017, a year earlier than previously expected, according to the Washington Post. The report adds that Medicare’s eroding financial stability increases the pressure on authorities to crack down on fraud.
The Washington Post quotes Tony West, Leader of the Justice Department’s civil division, as saying, “I think you will see stepped-up enforcement in this area. You will see proactive and assertive efforts.” Health care, he added, has the “biggest single impact on the budget” and pursuing cases in that arena is “consistent with the president’s agenda on health-care reform. We are following his lead.”
Medical Identity Theft
Medical identity theft is deeply entrenched in the health care system, according to the World Privacy Forum. In a 2007 report (the last time federal data on the crime was collected), the group said more than 250,000 Americans a year were victims of medical identity theft. The report also stated that health care fraud accounts for an estimated 3 - 10% percent of all health care costs, or up to $120 billion of loss each year. The group also notes that the number of people identifying themselves as victims of identity theft has risen each year from 86,168 victims in 2001 to 255,565 victims in 2005.
Looking ahead, the World Privacy Forum, which plans to release new data this year, warns that medical identity theft is on the rise. In a recent article the New York Times states that experts argue the numbers are almost certainly increasing because of the growing number of electronic medical records systems being constructed without proper safeguards.
The NYT describes various forms of medical ID theft, including hackers using names and Social Security numbers for fraudulent medical charges like emergency medical services. Hackers can also use stolen insurance information, like the basic member ID and group policy number found on insurance cards, to impersonate victims — and receive everything from a routine physical to major surgery. Even more common, the NYT reports, are cases in which medical information is stolen by insiders at a medical office and sold on the black market or used to make fraudulent billing claims.
It’s not just a financial worry. Medical ID theft can be deadly, notes the NYT. Medical records used for fraudulent care may contain erroneous vital information used to treat patients, like blood type, allergies, prescription drug use or medical history.
Privacy advocates have growing concerns that medical providers may not have the proper precautions in place - especially in light of President Obama’s plans to spend $20 billion to increase the use of electronic medical records nationwide as part of the stimulus package, adds the NYT. The report quotes Pam Dixon, Executive Director of the World Privacy Forum, as saying, “Without aggressive safeguards, we could be building an infrastructure for massive medical fraud.”
If you want to indentify and protect your organization or corporation from fraud or discuss your firm’s talent or overall security needs, contact A.E. Feldman’s President, Mitch Feldman, today.
