Healthcare fraud is a deliberate act of deception or misrepresentation of healthcare services for unlawful profit or benefits.
Individuals and institutions can commit healthcare fraud, including medical providers, patients, healthcare insurance members, or those within other aspects of the healthcare system. Since it is a federal offense, the FBI often investigates these crimes along with state and local agencies and insurance groups, which can result in state and federal charges.
Why is health fraud considered one of the worst types of fraud?
While healthcare fraud is only committed by a small number of those in the system, it still negatively affects everyone — not just the victims of specific crimes.
For instance, the impact can lead to increased costs that are shared by everyone, like higher premiums and increased out-of-pocket costs.
Additionally, this type of crime can lead to mistrust between patients and providers and decreased perceived value and integrity in the health system and providers. As a result, some people may be less likely to pursue healthcare services, which can lead to them delaying care.