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Disturbing Financial Fraud in Healthcare

By Donald R. Soeken,  Posted by James Murtagh (about the submitter)     Permalink       (Page 1 of 2 pages)
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Headlined to H3 6/15/11

But Why Haven't They Been Reported?

Disturbing New Statistics Show Huge Percentage Of Financial Fraud Against U.S. Government Comes From Healthcare Industry

By Donald R. Soeken, LCSW-C, Ph.D.

Ever wondered who the biggest culprits are, when it comes to defrauding the taxpayers of the United States?

The answer to that question may surprise you.

According to some shocking new statistics from the nonprofit Taxpayers Against Fraud (TAF) public interest group, the ranks of the admitted federal cheaters are occupied almost entirely by health insurers and the healthcare pharmaceutical industry.

That's the clear and thoroughly disturbing conclusion to be found in a revealing TAF study of the "Top 20" fraud lawsuits (ranked by dollar amounts) to have been decided by court judgments or agreed-upon settlements in recent years. Amazingly, the list of penalty awards as adjudicated under legal procedures mandated by the U.S. False Claims Act contains no fewer than 19 healthcare or health insurance entities . . . and only a single financial entity who isn't engaged in the business of health insurance or medical care.

Astonishing? You bet it is. Even a quick look at the list of recent fraud convictions and fraud case settlements involving the U.S. healthcare industry (to review them for yourself: ) should be enough to make any alert taxpayer ask: Why haven't all of these obvious fiscal abuses by healthinsurers and the pharmaceutical industry been reported in the news media . . . even as the entire nation continues to debate the future of healthcare reform?

As the Taxpayers Against Fraud website makes chillingly clear, some of America's most best known and most trusted healthcare industry corporations are heading up the list of despicable cheaters whose conscienceless manipulation of federal health dollars has resulted in convictions or financial settlements with Uncle Sam.

Some appalling examples from the TAF "Top 20": list:

No. 1 Fraud Offender: Pfizer -- $1 billion under the False Claims Act.

Pfizer paid a total of $2.3 billion, of which $1.3 billion was a criminal fine for kickbacks and off-label marketing and $1 billion was paid under the False Claims Act.

No. 2 Fraud Offender: Tenet Heathcare -- $900,000,000 under the False Claims Act. In July 2006, Tenet Healthcare agreed to pay the Federal Government $900 million for billing violations that included manipulation of outlier payments to Medicare, as well as kickbacks, upcoding, and bill padding.

No. 3 Fraud Offender: HCA -- $731,400,000 under the False Claims Act.

In December 2000, HCA The Healthcare Company (formerly known as Columbia HCA), the largest for-profit hospital chain in the United States, pled guilty to criminal conduct and agreed to pay more than $840 million in criminal fines, civil penalties and damages for unlawful billing practices.

No. 4 Fraud Offender: Merck - $650,000 under the False Claims Act.

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