Winners & Losers

By the time the authorities are knocking on their door, it's too late. As they're led out of their homes or offices, a thousand things must go through their minds. It's the father who gets arrested in front of his son. It's the sixty-something year old doctor who might possibly spend the last days of his life in jail. But before getting to this point, maybe the prospect of going to jail wasn't enough of a deterrent. Maybe even the potential of being arrested in front of their families, friends, or coworkers didn't weigh heavy enough upon them to dissuade them from making a very bad choice. But at some point, a rationale person would have to stop and think about the consequences of being caught.

The fight against insurance fraud is an ongoing battle with schemes becoming more and more elaborate every day. The opponents in this epic battle are law enforcement and the insurance industry facing off against anyone and everyone who engages in fraud. And sometimes watching the sides go back and forth can be a dizzying experience. With so many new schemes emerging on a daily basis, it's often challenging to keep score of whose winning and losing.

Clearly those who perpetrate these schemes put a lot of time, thought and energy into them. If only that same time, thought and energy were used to help others rather than commit crimes. A recent alleged scheme involved restaurant employees who used a device to skim account information from the credit cards of their customers. The information was reportedly transferred to a new physical credit card and used to rack up fraudulent charges. Another alleged scheme involved an organized ring of more than 100 people including doctors, nurses and other medical professionals who may have defrauded the Medicare system out of $452 million through false billing. In both cases, the perpetrators were caught, charged and now facing possible conviction. Despite all the news about other fraud perpetrators being caught and convicted, here again maybe the message "It's not worth it" just didn't hit home.

Regardless of whether one person engages in a scheme or an organized crime ring perpetrates a series of schemes, fraud is fraud and sooner or later, those who commit these crimes will be caught. It's not a matter of if; it's a matter of when. From the person who pads their claim to get a little extra money to the doctor who bills for services not rendered, it all equates to a multi-billion dollar problem. And it's a problem in which we're all victims because we all pay the costs.