Teaming Up: Public-Private Partnership to Prevent Healthcare Fraud. Why Should We Care?

Thanks to the Affordable Care Act, healthcare is once again a hot button topic in the media. Ranging from contentious debates between those who are for or against it in the media, at home, or even in crowded lunch rooms. Regardless of one’s position there is one common denominator, everyone one hates healthcare FRAUD.


Fraud is defined as making dishonest statements or representations of material facts to acquire some benefit or payment for which no entitlement would otherwise exist. This ranges from individuals, institutions or groups. Healthcare fraud costs approximately $80 billion yearly with national health care spending surpassing $2.7 trillion (FBI). Health care fraud drives up health care cost with Medicare fraud being at the forefront. Why Should We Care? Simple. Medicare fraud cost taxpayers billions of dollars and places undue strain on the federal and state budgets (MLN). In this economic climate and healthcare reform crossroads stricter initiatives are needed to protect taxpayers’ dollars and maintain a viable healthcare infrastructure to meet the needs of its beneficiaries.

A move in the right directions is showcased by the announcement made this year by the Secretary of Health and Human Services (HHS) Kathleen Sebelius and Attorney General Eric Holder about a new voluntary public-private partnership (PPP) among the federal government, state officials and several private health insurance organizations to fight against health care fraud. Examples of organizations that has joined this group is Blue Cross Blue Shield Association, Federal Bureau of Investigations and the National Insurance Crime Bureau. The purpose of this new partnership is to share information to improve the recognition of fraudulent practices, bringing those responsible to justice and recouping taxpayers’ dollars. Healthcare fraud occurs in many different forms and it is imperative that we the taxpayers remain vigilant and report any healthcare fraud. Examples of healthcare fraud is intentionally billing for services that were not done or altering claims forms and receipts to receive a higher payment (HHS).

Although, there are several laws already in place such as the Anti-Kickback Statue, Physician Self-Referral Law, Society Security and the Affordable Care Act which stands to strengthen these laws by providing tougher sentences for violators this new public-private partnership is revolutionary in that it bridges the communication gap between these stakeholders in order to protect scarce healthcare dollars.

[1] FBI

[2] Medicare Learning Network

[3] U.S Department of Health & Human Services


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