The Staggering Scope of Health Care Fraud: A Discussion With Keller Grover

07/13/2015 // KellerGroverWB // Kathleen Scanlan // (press release)

It is no secret that fraud — particularly in health care — is a big and weighty problem, diverting funds from intended uses and steering them into the wallets of wrongdoers. But the actual scope of fraud is likely far greater than most people think. Indeed, the numbers are staggering. In health care alone, experts estimate fraud’s toll at between $100 and $300 billion per year.  It is one price we should not have to pay — and with help from whistleblowers, we can fight back.

In a new Google Hangout from the law firm Keller Grover, veteran whistleblower lawyer Kathleen Scanlan puts the magnitude of health care fraud in its full — and troubling — perspective.  She provides a vivid sense of just how much fraud costs the health care system, and taxpayers who fund programs like Medicare and Medicaid, which dole out some $1 trillion in claims each year.

In the video, now available for online viewing on YouTube at http://youtu.be/FrqorlypHQE

Scanlan also explains how whistleblowers — those who know of, or strongly suspect wrongful behavior — can take steps to sound the alarm, and often be rewarded for their efforts.

“We’ve become de-sensitized to how much money we’re really talking about with fraud on government healthcare programs,” says Scanlan.  “Think about what $100 billion in fraud on these programs translates to.  It is the equivalent to $300 per year for every man, woman, and child in the United States.  It is two times the sum the U.S. government spent to bail out General Motors – and we’re doling it out every year.  And these are just the estimates of the amount that might be lost to fraud each year.  Clearly, before we can root out health care fraud, we need to get better at identifying it.

Whistleblowers, Scanlan says, have proven a remarkably effective way to identify fraud.  “Whistleblowers are individuals — often those who work inside the organizations carrying out the improper activity — who can shed light on a scam,” she adds.  “They are our eyes and ears, and we have to do everything possible to support and incentivize them; to encourage them to speak out.”

Fortunately there are some powerful means by which we do this.  The premier whistleblower law today is the federal False Claims Act, which enables someone who suspects fraud against the government to file a lawsuit alleging as much — and receive up to 30 percent of any recovery the government ultimately obtains.  The False Claims Act also prohibits retaliatory action against whistleblowers, such as termination and demotion for speaking out about known or suspected fraud.

“What the False Claims Act does is tell those who know of or suspect fraud that we want them to step forward, that we will support, protect, and — when there is a recovery — reward them,” says Scanlan, whose firm has offices in Los Angeles and the San Francisco Bay Area.  “Fraud — in health care in particular — is a problem of staggering dimensions, as the numbers show.  But whistleblowers have created a staggering number of their own: the billions of dollars they help the government recover each year — funds that can then be steered back to the uses for which they were intended.”

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