March 26, 2014, by Holly Chavez – It seems that it’s nearly a daily occurrence that we hear about someone being arrested for committing fraud in one way or another. It’s a sad fact that, whenever there is the chance to get free money, someone is going to unfairly take a shot at it. One area with a huge fraud problem, both within organizations and on the individual level, is that of the healthcare industry. Whether people realize it or not, healthcare fraud affects everyone. Sadly, this includes the men and women of the military who sign up to protect us.
Healthcare Fraud by the Numbers
The Department of Justice is the government entity that handles cases of fraud committed against the United States. By using the False Claims Act, a statute signed into law by President Lincoln over 150 years ago, the Justice Department is able to hold those who commit fraud against the government responsible for their actions.
The attorneys of Goldberg Kohn inform us that, “in 1986, the False Claims Act was amended to significantly expand the role of whistleblowers in rooting out fraud against the government. The False Claims Act allows private citizens to sue individuals or businesses who defraud the government, and receive an award for doing do.” The latest statistics show that the government recovered $3.8 billion in fraudulent claims using this vital tool, and sadly, a large portion of this was from the healthcare field.
Of the aforementioned $3.8 billion recovered, a full $2.6 billion was related to healthcare fraud. The majority of this recovery was related to fraudulent claims against Medicaid and Medicare, but TRICARE was also another target of fraudsters. A large contributor to this problem was false claims related to medical devices and drugs; this accounted for more than $1.8 billion recovered. Sadly, this may only be the tip of the iceberg, and while they may not realize it, our servicemen and women are being directly affected.
Effect on Military Benefits
Fraud has a detrimental effect on military healthcare benefits. The most obvious and quickest felt is when servicemen and women legitimately need these benefits but are put through the wringer to ensure they’re not committing fraud. The huge financial loss caused by healthcare fraud means that the government must be more careful about approving benefits, and unfortunately, this means that important treatments could be held up in an effort to ensure a claim isn’t fraudulent.
A much larger problem, however, which comes on so slowly that many people don’t even recognize it, is that of increasing medical costs for veterans and active duty soldiers. The money lost to fraud doesn’t just magically get replaced. Fraudulent claims that are paid end up resulting in higher healthcare costs for all, and when it’s the government providing healthcare benefits, they’re going to save money whenever possible. Sadly, this is likely one reason why the Pentagon announced a budget that would mean those on TRICARE would end up paying higher deductibles and co-pays.
The more money that the government recovers from healthcare fraud, the more able they’ll be to avoid reducing military healthcare benefits; and in reality, the False Claims Act is their best tool in accomplishing this. While most people would report suspected fraud out of the goodness of their hearts, many are fearful that they could lose their jobs or suffer reprisals due to their reporting. This is where the False Claims Act comes in.
Under the False Claims Act, a person who reports fraudulent activities against the government is entitled to a financial percentage of whatever the government recovers. This could be up to 30 percent of what’s recovered, so in a best case scenario, a person who helps the government recover $50 million in fraudulently obtained funds could receive $7.5 million of that money. It’s imperative, though, for a person to speak with an attorney prior to reporting this fraud. This will ensure that they follow the appropriate legal procedure to receive their award.
It’s upsetting to know that there are those out there who will take advantage of the system in order to receive money and benefits that they don’t rightfully deserve. It’s even more upsetting, though, when a person finally understands that this fraudulent behavior directly affects those who are willing to make the ultimate sacrifice to protect their country. Fortunately, there are tools in the government’s arsenal to prevent these abuses, and with the help of morally-minded individuals who report fraud, the fight to keep military healthcare benefits easily available can still be won.
Holly Chavez is a freelance author, and she searched online for keywords like “Military Healthcare Fraud,” “The False Claims Act,” and “The attorneys of Goldberg Kohn,” while conducting research for this article. Holly’s brother retired from Air Force active duty and relies on military medical benefits for healthcare. She began to research the subject of military medical fraud after he told her that his TRICARE benefits went up, and the quality and availability of his prescription medicines went down.