Health insurance fraud continues to be a problem in New York as well as nationally. Nothing may illustrate this better than two recent reports, one issued by New York’s Department of Financial Services (DFS) and the other issued jointly by the U.S. Department of Justice (DOJ) and the U.S. Department of Health and Human Services (HHS). The two reports are striking not just because of the variety of the health insurance frauds they discuss, but also because of the immense amount of money they point out is at issue.

For example, the federal report, “Health Care Fraud and Abuse Control Program Annual Report for Fiscal Year 2017,” available at https://oig.hhs.gov/publications/docs/hcfac/FY2017-hcfac.pdf, notes that, in fiscal year 2017, the federal government’s health-care fraud prevention and enforcement efforts led to $2.6 billion being recovered from individuals and entities attempting to defraud the federal government and Medicare and Medicaid beneficiaries. That certainly is a substantial sum, but the DFS report, “Investigating and Combating Health Insurance Fraud,” available at https://www.dfs.ny.gov/reportpub/fraud/health_frd_rpt_2017.pdf, observes that losses due to health-care fraud are estimated in the tens of billions of dollars each year.

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