Health care is close to a $3 trillion dollar industry in the United States. It includes all those things humans do to diagnose, treat, and prevent disease, illness, injury, and other physical and mental impairments and is provided by caregivers, including hospitals, doctors, nurses, home health care providers and hospices. Americans pay for their health care in a variety of ways. Some have private health insurance through their employers. Some are finding health insurance under the new Affordable Care Act. However, millions of Americans rely on government-funded health care programs like Medicare and Medicaid to pay for their health care and prescriptions.
With nearly $3 trillion flowing through this industry each year, it should come as no surprise that health care fraud is rampant. The Federal Bureau of Investigation (FBI) estimates that health care fraud costs the country an estimated $80 billion a year in improperly paid health care claims. Since the government enters into agreements with physicians, hospitals, nursing homes, home health care agencies, pharmaceutical companies, pharmacies, or other health care facilities for billions of dollars in goods and services for the benefit of its programs’ beneficiaries every year, Medicare fraud makes up a huge portion of the total estimated health care fraud in this country.
There are several common types of health care fraud subject to False Claim Act liability, including Medicare fraud and Pharmaceutical fraud: