6 Biggest Government Health Insurance Frauds – Part 1

Health insurance fraud often goes undetected but there have been plenty of companies that have gotten caught and paid a huge price. Below are 3 biggest government health insurance frauds of all time.

1) Tenet Healthcare
The single largest fraud under the False Claims Act goes to Tenet Healthcare. In July 2006, Tenet Healthcare paid the government $900 million for billing violations. These violations included Medicare fraud, kickbacks and billing inflation. According to the Department of Justice, more than $788 million resolves claims of “outlier” payments, more than $47 million for kickbacks on Medicare patient referrals and more than $46 million for claims of “upcoding” for increased reimbursements.

2) HCA
HCA, the largest US non-profit hospital chain, actually holds the number two and three spots because they were caught twice. In December 2000 HCA pled guilty and agreed to pay more than $840 million in fines and penalties, $731 million of which was recovered under the False Claims Act. In this case, their fraud included “upcoding” for services, billing the government for advertising under the false pretense of community education, and receiving kickbacks from physicians. This fraud investigation became public in 1997 when the FBI raided various HCA hospitals.

3) HCA

To make matters worse, HCA agreed to pay another $631 million in June 2003. These false claims involved Medicare and other government health programs. They also paid another $250 million for overpayment claims. Combined with the 2000 case, HCA paid $1.7 billion, the largest total recovery ever in the US. No high level executives were ever charged, in fact, Rick Scott, the CEO of HCA at the time, is currently the governor of Florida.

To read about the next three cases click here

The information supplied in this article is not to be considered as medical advice and is for educational purposes only.