Fighting Health Care Fraud and Abuse

Efforts to fight health care fraud and abuse in private and public health insurance programs play an important role in protecting patients and payers. Fraud and abuse in the health care system has an enormous adverse impact on health care quality and safety, while also imposing higher costs on consumers, employers and taxpayers. The financial losses to health care fraud nationwide are estimated to range from $75 billion to $250 billion a year (National Health Care Anti-Fraud Association). Fraud and abuse also can result in serious harm to people who are subjected to unnecessary or inappropriate medical services – or to services by providers who are not licensed or qualified to provide them. Health plans are leaders in fighting health care fraud and abuse, and their effectiveness is demonstrated by the increasing degree that government health programs are adopting private health plan practices.