Healthcare fraud involves any deliberate deception or misrepresentation that results in unauthorized financial gain in the healthcare industry. Common fraudulent practices include billing for services not rendered, inflating charges, and providing unnecessary or substandard care. For instance, a healthcare provider may bill for a more expensive procedure than the one actually performed or claim reimbursement for services never provided.
Combating healthcare fraud is crucial to protect the integrity of the healthcare system, prevent financial losses, and ensure the appropriate use of healthcare resources. Historically, healthcare fraud has been a significant issue, costing governments, insurers, and individuals billions of dollars annually. To address this, various measures have been implemented, including