Fraud Waste And Abuse

As an insurance agent there are numerous certification courses that are mandatory if you want to sell insurance in your state. One of those courses is one on Fraud Waste and Abuse in the healthcare industry. The government is trying to minimize abusive practices in the healthcare industry by having agents take these courses. The sad thing is no matter how many regulations you have, whether old or new, you are still dealing with people. All the way from seeing a doctor in his office, taking tests at the lab, ordering your prescriptions, in every phase of your healthcare there are numerous people involved.

There are researchers that have surveyed doctors in the U.S, from a wide range of specialties, and found that most believe that up to 30% of medical care is not needed. Breaking it down even further, 22% of prescription medicines, 25% of medical testing, 11% of medical procedures, and 11% of overall care was not needed.

When you add all that up you’re looking at over 200 billion dollars of waste and abuse in the healthcare industry. That is a staggering amount. This in turn is part of the reason for insurance premiums to continually rise and your overall healthcare costs. A couple of other reasons for waste is that many patients are requesting testing or other procedures to be done unnecessarily and you also find some doctors just trying to boost their profits. Another reason for all the tests and procedures is that physicians are being extra careful and making sure they aren’t left open to a  lawsuit later on down the road. So even lawyers are partially involved in all this mess.

I believe everyone needs to take an active role in trying to cut down on fraud waste and abuse practices. The doctors, nurses, hospital personnel, insurance agents, pharmacists and yes the patients themselves. I know after my doctor visit I usually get a survey, either through a phone call or an e-mail. This is a great opportunity to give your overall opinion of the services you received, and if you saw something that you felt was a concern, mention it in the survey. Most healthcare providers and healthcare facilities, along with pharmacists and those involved in the healthcare field are receiving training in this area. One can only hope that it will make an impact down the road and make us more efficient in this area.

— Dave Obregon | 888-355-1599

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