How Healthcare Fraud and Abuse Perpetuate Health Disparities in the U.S.

By Alanna M. Lavelle , Timothy L. Helms

Healthcare fraud losses amount to tens of billions of dollars per year. Vulnerable individuals are most like to receive medically unnecessary and harmful care, driving health disparities. MITRE’s Program Integrity team outlines a call to action.

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A significant challenge for the U.S. healthcare system involves the often-staggering amount of healthcare fraud and abuse—estimates in the tens of billions of dollars annually—that occur across the country. In addition to the financial costs of healthcare fraud and abuse, there are also other considerable impacts experienced by fraud and abuse victims. There is a critical interrelationship between healthcare fraud and health disparities, as vulnerable and medically underserved beneficiaries are routinely targeted, and often receive substandard, medically unnecessary, and even harmful care.

Those most vulnerable suffer from entrenched weaknesses in our healthcare system that fail to consistently provide high quality care to everyone, regardless of their social, economic, and/or environmental disadvantage. Consequently, healthcare fraud and abuse can be easily overlooked health determinants that contribute to or perpetuate existing health disparities.

“How Healthcare Fraud and Abuse Perpetuate Health Disparities in the U.S.” outlines the physical, economic, and intangible harm to patients’ interests caused by healthcare fraud and how it intersects with and drives health disparities. In addition to case studies of healthcare abuse and fraud that targets medically underserved and vulnerable individuals, the technical paper covers detection, response, and mitigation efforts undertaken to stymie this abusive behavior and its impact.

Finally, the paper outlines a call to action through seven recommendations that should be considered to mitigate the impact of healthcare fraud and abuse on people who disproportionately experience health disparities.