According to recent data published by the U.S. Center for Medicare & Medicaid Services, in 2017, U.S. healthcare spending reached $3.5 trillion or $10,739 per person, comprising 17.9% of the U.S. gross domestic product. Healthcare spending is predicted to grow 5.5% over the next decade, reaching nearly 20% of the gross domestic product by 2027. Much of this spending is driven by ever-increasing costs of medical services and drugs, with basic medical services often costing tens of thousands of dollars, and life-saving drugs costing patients hundreds of thousands of dollars per year.
Fraud is pervasive in the healthcare industry. By many estimates healthcare fraud costs the nation, conservatively, over $70 billion a year. With the opportunity for extraordinary gain, doctors, pharmaceutical companies, medical device companies, insurers, and others often take advantage of the complexities of the healthcare system to line their own pockets at the expense of taxpayers.
Fortunately, whistleblower laws, including the False Claims Act, have proven to be powerful tools in combating healthcare fraud and providing public restitution for the loss suffered. The United States has consistently recovered more than $2 billion a year for healthcare fraud under the False Claims Act, recovering more than $2.5 billion in 2018. The vast majority of these recoveries are the result of whistleblowers coming forward.
There are many types of healthcare fraud schemes. While complex in execution, they are often simple in concept, and include the following: