Healthcare fraud in United States costs tax payers nearly $100 billion per year, according to the U.S Department of Justice, and compromises the authentic healthcare needs of millions of citizens. As criminals have developed new methods of falsely profiting from programs such as Medicare and Medicaid, the government has harnessed the power of technology, a nation wide strike force, and existing security laws and regulations to capture criminals abusing our healthcare system.
ePHI as the fuel for fraud
Most people recognize ‘Identity Theft’ as associated with financial information, but what they don’t know is that their electronic protected health information (ePHI) is most valuable to fraudsters. According to the Ponemon Institute, the average cost of a stolen record among 17 industries is $140 dollars. Healthcare incurred the highest cost per stolen record at $380 dollars with financial services trailing at $336 dollars. Why does ePHI fuel fraud so well? ePHI can be used for false billing involving Medicare or Medicaid, generating millions and even billions in false claims. With healthcare being a heavily regulated industry, it often takes months to identify when a breach of information has occurred giving fraudsters time to organize and monetize on the stolen information.