posted by Winthrop Cashdollar, AHIP, Executive Director, Product Policy
on January 8, 2020
It is not unusual to see a story about health care fraud in the newspapers from time to time – but in the Sports section?
Last week the U.S. Department of Justice announced that 10 former National Football League (NFL) players have been charged with defrauding the Gene Upshaw NFL Player Health Reimbursement Account Plan, a health care benefit program for retired NFL players. The retired players allegedly submitted over $3.9 million in false and fraudulent claims to the health benefit plan, and received more than $3.4 million between June 2017 and December 2018, according to a Justice Department release.
The former players allegedly submitted false claims for expensive medical equipment – typically $40,000 to $50,000 for each claim – that was never purchased or received. The claims included hyperbaric oxygen chambers, cryotherapy machines, ultrasound machines designed for use in a doctor’s office, and electromagnetic therapy devices designed for use on horses.
The case was investigated by the FBI and is being prosecuted by the Health Care Fraud Unit of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of Kentucky.
Most of the time, health care fraud is not front-page news. A great deal of health care fraud goes unreported – and a great deal of health care fraud goes undetected. The National Health Care Anti-Fraud Association (NHCAA) estimates that the financial losses due to health care fraud in the United States are in the tens of billions of dollars each year.
Health care fraud is an intentional deception or misrepresentation by the perpetrator to gain unauthorized benefit for the perpetrator or some other party. Health care fraud takes many forms – from insurance claims for health care goods or services never provided to medical identity theft.
Health care fraud is not a victimless crime. It raises health care costs for everyone and can result in patient harm, such as when providers subject patients to unnecessary treatments.
If you suspect health care fraud, how should you report it? The NHCAA has compiled resources to facilitate the reporting of health care fraud.