When people think healthcare, certain things percolate in the mind like deductibles, insurance companies, marketplace, to name a few. What most don’t think of is healthcare fraud.

On September 17, 2021, the Department of Justice (DOJ) announced startling results for the 2021 “Healthcare Takedown” – a nickname given for the annual announcement of fraudulent incidents across the states resulting in billions of dollars.

This year in particular 138 defendants were brought forth in criminal charges, 42 medical professionals inside of 31 federal districts amounting to a total of $1.4 billion dollars in losses. This amount is less than 2020’s amount of $6 billion dollars and 345 defendants. Still, this gaudy number is mind blowing.

The 4 main areas of fraud were detected in:

  • Telemedicine – schemes in care compromising $1.1 billion.
  • Covid-19 – resulting in $29 million in false claims for federal funding.
  • Sober Living Homes – illegal conduct: kickbacks, medically unnecessary lab tests and therapy totaling to $133 million in false claims.
  • Opioids Prescriptions – 19 defendants who prescribed over 12 million doses of opioids and other narcotics and submitting well over $14 million in falsely billed claims.

While substance abuse and addiction has taken a backseat to all mainstream medias in the wake of the Covid-19 pandemic, researchers have concluded there to be a 30% spike in overdose related deaths in the past year. The DOJ announced to focus on the opioid and substance abuse care, and fraud for the coming year to ease the cycle of fraud.

Even though these numbers are daunting, and the greatest concern being whether or not to trust a substance abuse or mental health facility, the best thing to do is make certain the facility is licensed and accredited by CARF (Commission on Accreditation of Rehabilitation Facilities) or JCAHO (Joint Commission on Accreditation of Healthcare Organizations). These specific licensures, on top of a state license, ensure the facility is practicing within the regulations stipulated to them by the government. Most insurance companies are now requiring substance abuse and mental health facilities to be state licenses and accredited with either CARF or JCAHO ensuring the potential patient is getting the highest quality of care.