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more_legal_areas consumer_fraudAs times evolve, the ways of attempting and carrying through health care fraud becomes more complex and sophisticated. Due to the enormity of the health care industry, it has become a very difficult task trying to combat instances of health care fraud that costs taxpayers billions of dollars every year. Since health care fraud can occur among physicians, companies, device dealers, contract carriers, labs, hospitals, nursing homes, home health care agencies, and individuals, the health care system is being affected by fraudulent practices in every arena of the industry.
Health care fraud was found to have infiltrated every facet of the health care industry when 17 FBI field offices investigated pharmacy fraud from 1989 to 1992, uncovering corruption at all levels. The continuation of health care fraud instances increasing over the years has made it one of the most challenging areas of law enforcement. Creating tremendous financial costs for the entire nation, a Health Care Fraud Unit was established in 1992 as a separate unit within the Financial Crimes Section of the Criminal Investigative Division in the FBI.
At the end of 1993, the Attorney General designated health care fraud as the Department of Justice''s second enforcement priority. The investigations are not actually conducted by the Health Care Fraud Unit, rather the Unit''s function is to support and provide guidance to the field offices. The federal enforcement agencies that share responsibility for investigating health care fraud include the FBI, the U.S. Postal Inspection Service, and various Offices of Inspector General.
Some states have since established special fraud units to investigate health care fraud, in addition to many private insurance carriers and private sector health insurers and enforcement agencies. There are many ways health care fraud can be committed. For example, billing for non rendered services, billing for medically unnecessary services, double billing, billing for a higher amount than provided, as well as countless other schemes.
When health care fraud occurs, it threatens the overall quality of health care being received. In 1999, annual health care expenditures in the U.S. totaled nearly $1.1 trillion, with losses due to health care fraud and abuse at estimates as high as ten percent of the nation''s total annual health care expenditure.
Funding received as a result of the passage of the Health Insurance Portability and Accountability Act of 1996 allowed the FBI to increase the number of Agents that were assigned to health care fraud in the following years. As a result, the active number of health care fraud investigations increased, as well as convictions. There is still such a widespread amount of health care fraud and anyone with information pertaining to it is encouraged to contact the proper authorities.
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