Justice News Flash: Featured Column : Why #Whistleblowers Trump Experts When It Comes to Estimating Healthcare Fraud

Why #Whistleblowers Trump Experts When It Comes to Estimating Healthcare Fraud

Experts estimate that between $100 billion and $300 billion is lost annually in health care fraud in the United States.

health care fraud in the United States.
Why #Whistleblowers Trump Experts When It Comes to Estimating Healthcare Fraud

// Justice News Flash: Featured Column (Press Release) // Kathleen Scanlan
Experts estimate that between $100 billion and $300 billion is lost annually in health care fraud in the United States. That sentence is so loaded it needs to be broken down.

First, that translates to between $300 and $900/year for every man, woman and child in this country. How many people actually consider that they're writing a $25 to $75 dollar check every month to fraudsters? Maybe they aren't doing it directly, but the reality is that since Medicare and Medicaid are this country's largest healthcare programs, taxpayers are writing checks month in and month out that go to fraudulent claims.

Second, look at what the experts are actually saying by this estimate. There is a whopping $200 billion difference between the high and low estimates of what "may" be lost to fraud every year. Even experts are not sure if the government gets fleeced out of $200 billion – every year. That's a massive sum to be essentially unaccounted for. Israel's entire Gross Domestic Product is $200 billion. The controversial one-time bailout of GM during the financial crisis only cost the government $49.5 billion. In other words, every year the United States doesn't even know if it loses the equivalent of what a major industrialized country produces, or 4 GM bailouts, give or take.

Here are some facts about the $200 billion that may, or may not, be lost to fraud. When new, a stack of 232 one-dollar bills is an inch thick. That means that $200,000,000,000 would be a stack of one-dollar bills more than 13,600 miles high. Tip the stack over and it would reach from San Francisco to New York 4.68 times. Using the dimensions of each bill (2.6” x 6.1”), 200,000,000,000 dollars would carpet more than 790 square miles. That's enough dollar bill carpeting to cover every square mile of Los Angeles and New York – with money left over.

There is a way to curb healthcare fraud and make sure that taxpayer dollars are not carpeting Los Angeles and New York – or any other American city -- with dollar bills, whether literally or figuratively. Experts may not be able to accurately calculate the fraud on the government healthcare programs every year, but there are plenty of people working in the healthcare industry who could expose the frauds that make all those estimates so inexact. Whistleblowers are singularly situated to expose the things the experts just don't know.

Finally, even if the experts could more accurately estimate the government's losses to fraud, they wouldn't be stopping it. In contrast, whistleblowers can and do stop it using the False Claims Act. Still not convinced? In 2008, the government funded the controversial bailout of AIG at a cost of a little more than $180 billion. When that investment returned a profit of more than $20 billion to the federal government it was considered a huge success. In contrast, recent estimates show that for every dollar the government invests in False Claims Act cases it recovers $15.

To recap, the experts don't really know how much healthcare fraud on the government is happening but there are people out there who do. There is also a law that will allow those people to not just expose the existence of the fraud for the experts to quantify, but to actually recoup those amounts for the government. And, the cost of doing all this is wildly more efficient than other government investments that have "returned a profit" for the government in the past. That's why whistleblowers trump estimators every time.


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