Health care fraud is not a victimless crime, as it results in higher costs for health insurance for individuals and employers and fewer resources are available to contribute to government programs such as Medicaid and Medicare. The Department of Justice (DOJ) and the Department of Health and Human Services monitor and enforce healthcare regulations. Specifically, the FBI investigates public and private healthcare fraud in targeted areas involving:
- durable medical equipment
- hospitals
- physicians
- home health agencies
- beneficiary-sharing
- chiropractors
- drug diversion in pain management
- physical therapists
- prescription drugs
- identity theft
Although healthcare fraud is difficult to detect and even more difficult to prosecute successfully, the FBI sentences healthcare providers as the below 2017 FBI June headlines illustrate.
- Sports Medicine Doctor Sentenced to One Year in Jail for Accepting $60,000 in Cash Bribes for Prescription Referrals
- Physical Therapist Sentenced for Obstruction and Tax Fraud Offenses
- Physician and Wife to Pay $1.2 Million to Settle False Claims Act Allegations for Billing Medicaid and Medicare for Unapproved Drugs
- Owner of New England Compounding Center Sentenced for Racketeering Leading to Nationwide Fungal Meningitis Outbreak
- Five Doctors Plead Guilty in Connection with Test-Referral Scheme with New Jersey Clinical Lab
- Office Manager/Medical Biller in TX Sentenced to 17 Years Imprisonment for $3.5 Million Health Care Fraud Scheme
- RGV Durable Medical Equipment Company Owner and Four Others Sentenced in Health Care Fraud Scheme
All of the above are examples of white-collar crimes and indicate that healthcare fraud is a significant social problem in the U.S.