Healthcare Fraudsters Steal $1.1. Million Per Case, Outpacing Other Industries

Dallas was home to the largest healthcare fraud case in the country this year, as guilty verdicts came down for a number of defendants in federal court for $200 million worth of fraud in the Forest Park Medical Center case. Data from the Association of Certified Fraud Examiners shows that when owners and executives commit fraud, healthcare executives take even more than other industries.

Healthcare fraud adds to the healthcare costs of everyone, as insurance companies and employers that make fraudulent payments have to get that money from somewhere, often resulting in increased premiums that have contributed to the country’s skyrocketing healthcare costs. The average household has gone from spending 7 percent of its income on healthcare in 1996 to over 23 percent today.

The Association of Certified Fraud Examiners put together an infographic that gives a look into healthcare fraud nationwide, and it revealed that owners and executives in the healthcare industry stole a median of $1.1 million per fraud case, compared to $850,00 across all industries.

They found 158 cases of healthcare fraud nationwide, with over half of cases focusing on corruption and billing issues. Tips resulted in detection of the fraud in 46 percent of cases, while internal audits caught just 16 percent. If the fraudster had more than five years of experience, they caused a $255,00 median loss for their company, while employees with less than five years on the job caused a median loss of $85,000.

Accounting was the most common sector in healthcare for fraudsters to work, which makes sense given their access to financial documents. Perpetrators were often identified because they were living beyond their means, financial difficulties, or having a close relationship with a vendor or customer.

While executives and owners were responsible for just 21 percent of fraud cases, they caused a medan loss of nearly $1.1 million, compared to managers, who caused a $100,000 median loss, and employees who accounted for 38 percent of cases caused a $48,000 median loss.

Check out the entire infographic below.

(Courtesy of: Association of Certified Fraud Examiners)