Public Attitudes Toward Healthcare Fraud: Reasons to Commit Fraud and Common Schemes

Cases of health care fraud have been on the rise in recent years and are believed to continue to increase over time. Every year a significant amount of the federal healthcare budget is lost to fraudulent claims by providers and/or to government agencies involved with the enforcement of the healthcare laws and prosecution of offenders. This study investigates the reasons for committing fraud and finds that the primary contributing factors are the explosion in the size of health care spending and the ever expanding network of providers and subscribers of health care services causing wide access to the system. While fraud is committed against both public and private health care agencies, the primary emphasis for prevention and reporting of fraud is on the public side (Rosenbaum et. al., 2009). The research investigates whether there are any differences in public attitudes towards fraud committed against the public agencies versus the private insurance companies. The study selects two equal samples and mails to each group a survey that includes similar questions pertaining to either Medicare/Medicaid or private insurance companies. The results show that both groups of participants view the fee-for-service payment system where doctors and other providers are tempted to perform or bill for unnecessary services as the most important reason for fraud. In addition, both groups rated double billing and incorrect reporting of diagnosis or procedures as the top two schemes committed against health care agencies.