The Impact of Healthcare Fraud

We rely on doctors, nurses and other medical professionals to keep us safe and healthy. Timely diagnosis can save lives, while reliable, regular care can help prevent countless headaches and heartaches for patients and their families.

All too often, however, medical professionals and facilities sacrifice patient well-being for a quick payoff. In cases of healthcare fraud, taxpayers’ money can be used, but it is patients who pay the ultimate price. When medical professionals act unethically and prioritize profit over patients, individual patients may be neglected, abused, or harmed, and important health concerns may go unaddressed or be overlooked.

How healthcare fraud affects patients

Healthcare fraud harms patients in a myriad of ways—some directly and some indirectly. As taxpayers and beneficiaries of the system, fraudsters’ misappropriation of funds means there is less money available for everyone. Healthcare fraud is a strain on an already overburdened public health system, making it difficult for reliable and ethical doctors and nurses to work at fair costs.

However, there are also some very immediate and dangerous ways that healthcare fraud can harm patients. For example, a recent study reported that patients seen by practices that were later banned from the Medicare program for fraud reports were 14 to 17 percent more likely to die early than patients seen by more ethical practices. This study from the Johns Hopkins Bloomberg School of Public Health attributes more than 6,700 premature deaths to in-office treatment in one year alone, which were later linked to fraud reports. In addition, patients treated by organizations later accused of fraud were up to 30 percent more likely to require hospitalization in the same year they received that treatment.

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Of these premature deaths and emergency hospital admissions, some can be attributed to simple neglect. A common form of healthcare fraud, for example, is billing insurers for services that were never provided. In a September 2021 enforcement action, the Justice Department collected $1.1 billion from over 43 defendants who allegedly made false telemedicine claims. The accused physicians are said to have virtually seen and treated patients with whom they either never met or wrote out prescriptions for follow-up discussions lasting minutes. This apparent neglect can result in doctors overlooking important conditions or not offering diagnostic tests that could save lives.

However, sometimes organizations go even further than neglecting their patients and actively harming them in order to increase their own profits. Some healthcare providers may order unnecessary and harmful diagnostic tests or treatments in order to charge for more services rendered. They can also force or prescribe opioids or other addictive substances that patients don’t need to create dependencies and bill for recurring prescriptions. Eventually, they may hire unqualified staff, including untrained or even abusive providers, who then provide substandard care to vulnerable patients.

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Even when healthcare providers simply provide ineffective services to patients while continuing to charge the full cost, they are causing harm. For example, many chain substance abuse rehabilitation providers have been accused of continuing to bill Medicare even though they exceeded state-licensed bed capacity, failed to maintain an appropriate patient-to-staff ratio, or hired unlicensed staff. Even when providers are not actively harming their patients, they still deny those who seek help the opportunity to receive meaningful and effective care.

Pharmaceutical companies and healthcare fraud

In some particularly damaging cases, drug companies can cut corners when developing life-saving drugs by dumping their waste and fraudulent practices on patients most in need. For example, in a recent Qui-Tam case, pharmaceutical giant McKesson was indicted in connection with the manufacture, distribution and sale of spoiled pre-filled syringes to cancer patients.

McKesson Corp, the fifth largest US company overall, was allegedly motivated out of sheer greed to offer kickbacks and sell potentially contaminated chemotherapy drugs to doctors and patients. It remains unknown how many immunocompromised cancer patients received the tainted McKesson syringes containing re-harvested “residual” drugs that were filled under uncontrolled conditions. However, millions of vials have been sold.

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How healthcare fraud harms the most vulnerable

All patients who come to the doctor deserve to be treated with respect. All too often, patients who pay for their services out of public funds, such as through the Medicare/Medicaid program, receive less attention and care than privately insured patients. Meanwhile, unscrupulous vendors rake in public money and neglect those who reach out to them with concerns.

Among those most likely to be negatively impacted by fraudulent medical providers include:

Reporting healthcare fraud and protecting patients

Healthcare fraud is a public health problem and a threat to individual patients. Reporting healthcare fraud helps remove unqualified and unethical providers from the system. If you speak up, you may qualify as a whistleblower for significant monetary compensation and protection from retaliation. Speaking up can help stop patient abuse and save lives.

If you have previously undisclosed information about healthcare fraud, you never know how many patients you might help by telling the truth today. If you have evidence or significant suspicion of healthcare fraud, speak to a qualified healthcare fraud attorney as soon as possible to learn how to start a Department of Justice investigation.

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