Healthcare Fraud Costs Us All Money, But Can Cost Some Their Lives

Healthcare fraudsters deliver measurably worse care that can harm patients. According to a new study from researchers at Johns Hopkins Bloomberg School of Public Health, patients treated by organizations later excluded from the Medicare program for fraud and abuse were between 14% to 17% more likely to die than those who were treated by their law-abiding counterparts. According to the study, fraud and abuse contributed to 6,700 premature deaths in 2013 alone.

Some fraud and abuse schemes involve organizations that bill Medicare for services that were never provided while others harm patients.  The study cited cases where untrained personnel read medical images, physicians doled out opioids that patients don’t need and companies developed counterfeit chemotherapy drugs.  The study went on to show that low-income, non-white, dual-eligible (in Medicare and Medicaid) and disable were more frequently targeted for fraud and abuse.

Those who were treated by a compromised organization were 11% to 30% more likely to experience an emergency hospitalization the year they received care.  “This suggests that fraud and abuse are one of the drivers of racial and socioeconomic disparities in the U.S.,” said Lauren Hersch Nicholas, assistant professor at Johns Hopkins and lead author of the study, adding that the findings are likely conservative estimates since relatively smaller cases often fall under the radar.

In 2018, more than 47,000 healthcare professionals were barred from Medicare and Medicaid, federal programs that provide health insurance to elderly, disabled, and low-income beneficiaries, because of fraud and abuse.  Researchers compared 8,204 Medicare beneficiaries who were first treated in 2013 by a provider later banned for fraud and abuse and 296,298 patients treated by a randomly selected provider who had not been banned for fraud and abuse. They tracked mortality and hospitalization for up to three years.

Nearly one-quarter (23%) of patients seen by excluded providers were non-white, while 16.5% of patients treated by non-excluded providers were non-white. More than 27% were disabled compared with 18.6% in the control group and 34.7% were dual enrolled compared with 21.9%.  More than 60% of patients in the sample were treated by providers found to be committing fraud. The remainder were treated by providers operating with a revoked license and those who were barred for patient harm.

The study found that providers excluded for fraud were associated with the highest mortality rate, at 17.3%. Patients who were treated by providers barred for operating with revoked licenses were 14.8% more likely to die, while those treated by providers excluded for patient harm were 13.7% more likely to die.

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