How Patients Pay the Ultimate Price for Healthcare Fraud
We rely on doctors, nurses, and other medical professionals to keep us safe and healthy. Receiving a timely diagnosis can save a life, while receiving reliable, regular care can help avoid innumerable headaches and heartaches for patients and their families.
However, all too often, medical professionals and facilities forgo patient wellbeing for a quick payout. In instances of healthcare fraud, taxpayer funds may be drawn down, but it is patients who pay the ultimate price. When medical professionals act unethically and put profit above patients, individual patients can be neglected, abused, or harmed, and important health concerns may go unaddressed or overlooked.
How Healthcare Fraud Affects Patients
Patients are harmed by healthcare fraud in a myriad of ways – some direct and some indirect. As taxpayers and beneficiaries of the system, having funds misappropriated by scam artists means that there is less money available for everyone. Healthcare fraud puts a strain on an already overloaded public health system, making it more difficult for reliable and ethical doctors and nurses to operate at fair costs.
However, there are also some very immediate and dangerous ways that patients can be harmed by healthcare fraud. For instance, a recent study reported that patients who were seen by practices which were later excluded by the Medicare program for reports of fraud were 14 to 17 percent more likely to die early than those who were seen by more ethical practices. This Johns Hopkins Bloomberg School of Public Health study attributes more than 6,700 premature deaths in one year alone to being treated by medical practices that were later connected to reports of fraud. Additionally, patients who were treated by organizations later charged with fraud were up to 30 percent more likely to need emergency hospitalization in the same year that they received that treatment.
Of these premature deaths and emergency hospitalizations, some can be attributed to simple neglect. For example, a common form of healthcare fraud is billing insurers for services never provided. In a September 2021 enforcement action, the Department of Justice collected $1.1 billion from over 43 defendants who allegedly submitted false telemedicine claims. The medical professionals charged were supposed to have seen and treated patients virtually with whom they either never met, or gave prescriptions to after calls that lasted mere minutes. These kinds of obvious neglect can cause physicians to miss important conditions or fail to offer diagnostic tests that could save lives.
At times, however, organizations may go even further than neglecting their patients and actively harm them in order to increase their own profits. Some healthcare providers may order unnecessary and harmful diagnostic tests or treatments in order to bill for more services rendered. They may also push or prescribe opioids or other addictive substances that patients do not need, in order to create dependencies and bill for recurring prescriptions. Finally, they may hire unqualified staff members, including untrained or even abusive providers who then provide substandard care to vulnerable patients.
Even when healthcare providers simply provide ineffective services to patients while continuing to bill at full cost, they are doing harm. For example, many chain providers of substance abuse rehabilitative care have been accused of continuing to bill Medicare while being in excess of state-licensed bed capacity, failing to maintain adequate patient-to-staff ratios, or hiring unlicensed personnel. Even if providers do not actively hurt their patients, they are still depriving those who seek out help the opportunity to receive meaningful and effective care.
Pharmaceutical Companies and Healthcare Fraud
In some particularly harmful cases, pharmaceutical companies may cut corners when creating life-saving drugs, passing their waste and fraudulent practices onto the neediest patients. For instance, in one recent qui tam case, pharmaceutical giant McKesson was charged in connection with the manufacture, distribution, and sale of tainted pre-filled syringes to cancer patients.
McKesson Corp, which is the fifth-largest US corporation of any kind, was allegedly motivated by simple greed to offer kickbacks and sell potentially contaminated chemotherapy drugs to doctors and patients. It remains unknown how many immuno-compromised cancer patients received the tainted McKesson syringes, which contained re-harvested “leftover” medication filled in uncontrolled conditions. However, millions of vials were sold.
How Healthcare Fraud Victimizes the Most Vulnerable
All patients who come to see doctors deserve to be treated with respect. All too often, patients who pay for services via public funding, such as through the Medicare/Medicaid program, are given less attention and care than those with private insurance. Meanwhile, unscrupulous providers cash in on public funds while neglecting those who came to them with concerns.
Those who are likeliest to be negatively impacted by fraudulent medical providers include:
Those who are dual-enrolled in both Medicare and Medicaid
Reporting Healthcare Fraud and Protecting Patients
Healthcare fraud is a public health issue, as well as a threat to individual patients. Reporting healthcare fraud helps remove unqualified and unethical providers from the system. Speaking up can qualify you as a whistleblower for a significant financial award, as well as for protections against retaliation. Coming forward can help stop the abuse of patients and save lives.
If you have previously undisclosed information about healthcare fraud, you never know just how many patients you may be helping by telling the truth today. If you have proof or significant suspicions regarding fraud in a healthcare setting, speak to a qualified healthcare fraud attorney as soon as possible to learn about launching a Department of Justice investigation.