An estimated $80 billion in health care fraud occurs every year. As a recent CNBC article points out, the problem has gotten worse in recent years, shifting from the typically suspect being an individual physician to organized crime among people who have no background in health care at all.

In battling the large problem of health care fraud, the federal government launched the Health Care Prevention and Enforcement Action Team (HEAT), a joint operation of the Justice Department, the Department of Health and Human Services and HHS-OIG. The task force focuses on areas which struggle with health care fraud the most. So far, nine cities have strike-forces, including Baton Rouge.

According to federal authorities, HEAT recovered $4.1 in 2011, and has been effective in reducing health care fraud.

Something our readers should understand is that proving intent to commit fraud can be tricky business. Prosecutors sometimes rely on unwarranted assumptions in order to make their case, and it is the task of a defense attorney to punch holes in the story they would like the court to accept.

In some cases, what looks like fraud may be mistake, and there may have not actually been the intent to deceive. In some cases, the fraudulent statements in question may not have related to a material fact on a health care claim.

Whatever the case may be, it is important to realize that the government has to prove its cases, and that it cannot always do so successfully.

Source: CNBC, “Stakes Are High-and Getting Higher-in War on Health Care Fraud,” Scott Cohn, April 3, 2012.