In a bold move to ramp up efforts to combat health care fraud in the United States, members of the health care industry have created the national Consortium to Combat Medical Fraud.

The Consortium is comprised of organizations from government, law enforcement, and the insurance industry. The founding members of the consortium include the Coalition Against Insurance Fraud, the National Health Care Anti-Fraud Association, and the National Insurance Crime Bureau, along with participation from the Federal Bureau of Investigation and Department of Justice.

Health care fraud pervades the entire health care industry and is becoming increasingly sophisticated. It is perpetrated by individual fraudsters as well as organized crime syndicates. The Consortium was designed to respond to the broad scope of health care fraud and the need for a multilateral, more integrated approach to the problem. The consortium will harmonize the efforts of these organizations by facilitating education and data sharing to better detect and prevent health care fraud.

As technology utilization in health care expands, so will the complexity of fraud. The emergence of electronic health records and insurance claims will undoubtedly give rise to increasingly sophisticated fraud schemes, further strengthening the case for greater cooperation within the health care industry and beyond.

The CHCAA has consistently cautioned that health care fraud is an equal opportunity crime that can be committed by any participant in the health care system. According to a recent report by the US government, it seems that this statement can apply even if the participant is six feet under ground.

The report stemmed from an investigation by the Senate Homeland Security Investigations Subcommittee, which revealed that approximately 500,000 claims were submitted to Medicare by deceased doctors over a seven year period (2000-2007) for durable medical equipment such as walking aids and wheelchairs. The panel estimates that Medicare lost between 60 and 92 million dollars over the given time period.

Each Medicare doctor is issued a unique provider ID (UPIN) when they register to practice. This number is then used by Medicare to make payments for the services they render. Unfortunately, Medicare does not always receive a notice that a particular physician has passed away. As a result, anyone who has access to that doctor’s UPIN can fraudulently bill Medicare for services or products and pocket the proceeds. The senate investigation found that fraudulent claims were submitted on behalf of 16,000-18,000 deceased doctors. Subcommittee Chair Senator Norm Coleman (R-MN) expressed shock at the magnitude of the problem, saying that “Medicare is a noble program and it is quite disturbing that so many people would try to exploit the program for their own gain.”

This is not the first time this phenomena has been uncovered. In 2001, the Inspector General of the US Department of Health and Human Services made a number of recommendations to address the problem that included issuing new provider ID numbers, but few of these suggestions were adopted. Currently, the government is planning to cross check provider information with Social Security status reports. Hopefully this will allow Medicare to track the status of their physicians and regularly update their records accordingly. Critics suggest that a lack of resources prevents these measures from going far enough because they fail to determine or address the actual source of the problem.

This is an excellent illustration of provider identity theft. It further underscores how the introduction of systems to manage massive amounts of provider data is a critical step in detecting and preventing health care fraud.

The US Food and Drug Administration (FDA) announced recently that it will take the fight to on-line sellers of holistic products that make grandiose claims about their ability to treat serious illnesses like cancer. The FDA has red flagged approximately 125 products because they have not been properly tested or approved by the FDA for use in combating or preventing diseases.

At the same time, they have sent 25 warning letters to companies making these claims in their product advertising to the public. Although the efficacy of these products has not yet been proven or disproven, the FDA generally adopts a cautious approach to new foods or drugs before approving them for specific use by the public.

The potential problems that arise in this case are two fold. First, patients may be spending significant amounts of money on products that provide no benefit for their condition. Secondly, it could be extremely dangerous to an individual’s health if they substitute a prescribed course of treatment with one that is untested and may cause harmful side effects or is incapable of treating them.

The FDA has embraced this initiative as part of its wider commitment to the North American trilateral health fraud working group (MUCH), which includes Mexico, Canada, and the US. Each year, this collaborative targets a different area of on-line health fraud that is impacting all three member countries.

In Canada, the Competition Bureau has taken the lead in monitoring and prosecuting these kinds of scams. This past March, the Bureau launched Project False Hope, an education and enforcement initiative aimed at targeting cancer-related health fraud on-line. As part of this initiative the Bureau has created two interactive web tools to help consumers protect themselves from becoming victims of online health scams. The Anatomy of an Online Health Scam is designed to teach you how to identify some of the tactics often used by scammers selling bogus cancer cures or treatments online. The Health Fraud Awareness Quiz tests your knowledge of scammers’ tactics and teaches you how to avoid falling victim.

The best way to protect yourself is through education, giving you the ability to spot the myriad online health scams that threaten consumers.