NCPA - National Center for Policy Analysis


July 16, 2004

An estimated $85 billion, or 5 percent of the $1.7 trillion spent on health care in the United States in 2003, was lost to health insurance fraud, reports the Atlanta Journal-Constitution.

According to the BlueCross BlueShield Association (BCBSA):

  • Fraud cost BCBSA plans $162 million in lost revenue in 2003, up 66 percent from $98 million in 2002.
  • Last year, BCBSA reported recovering $240 million from fraudulent claims, a 52 percent increase from 2002..

The most common types of fraud include performing unnecessary medical procedures, improperly prescribing drugs, billing for a more expensive service than was performed, and impersonating a health professional.

Investigators also found evidence of "rent-a-patient" schemes, in which physicians recruit patients to undergo procedures they don't need and then split the reimbursement with them.

Source: Vanessa Maltin, "Fraud plagues U.S. health care," Atlanta Journal-Constitution, July 14, 2004.


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