US university professor warns global healthcare fraud costs reach $850B
ANTALYA
Dr. Mohammed Ranavaya, a professor of medicine at Marshall University in the US, said on Saturday that “billions of dollars of insurance” fraud occur every year, making it a significant global problem.
“Healthcare fraud is increasingly prevalent, and it is an issue that is worldwide,” Dr. Ranavaya said during the 20th International Forensic Medicine Days, held in the Turkish resort city of Antalya, at the Foundation for Strengthening the Organization of Justice.
The event, in its sixth day, brought together heads of forensic institutions, academics, members of the judiciary, criminal law experts, lawyers, and forensic specialists from 26 countries.
During the panel, Ranavaya delivered a presentation on Fraud, Malingering, and Exaggerated Claims in Injury and Disability Cases in the US.
He stressed on Saturday that fraud is a criminal offense and carries legal consequences. He explained that individuals may fabricate physical or psychological symptoms to gain financial benefits, avoid work or legal responsibility, or obtain medication.
He noted: “Producing fake symptoms is a form of fraud. … Exaggeration is common, and overstating your claim occurs quite often. Judges are really used to looking at the overstating of the claim. So, overstating a claim about full fabrication, whether intentionally or unintentionally, can be exaggeration if it is unintentional.”
$850B lost to healthcare fraud
Highlighting the growing scale of healthcare fraud, Ranavaya, who has been practicing medicine for 47 years, emphasized that he has personally witnessed a sharp rise in fraud, particularly over the past 5-10 years.
He underlined that the issue is not confined to the US but is a global problem: “About $850 billion globally are wasted in fraud and abuse. … Private health insurance companies estimate around $230 billion, so somewhere near a quarter of a trillion dollars is wasted in the United States.”
He added that in the OECD countries, about 8% of healthcare spending is lost to fraud and abuse, while in the UK, the figure is around £1 billion (over $1.3 billion) annually.
Ranavaya noted that health insurance fraud is highly complex and spreads across many areas of the healthcare system, sometimes involving staged accidents where multiple claims are filed for the same incident.
He further pointed to an increase in cartel-related crime, explaining: “Because narcotics-related crime is becoming increasingly violent. … They have very heavy punishment, long jail terms. It is much easier to commit health care fraud and make the same amount of money without getting killed.”
At the end of the session, Hizir Asliyuksek, the head of the Council of Forensic Medicine and Chair of the 20th International Forensic Medicine Days, presented plaques to the speakers in appreciation of their contributions.
The event will conclude on Sunday.
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