This chapter discusses health fraud, including definitions of fraud and health care fraud. It provides examples of common health fraud practices such as making unrealistic claims and using meaningless jargon. The chapter explains how to check the authenticity of health products and services, defines health quackery, and discusses how fraud drives up health care costs. It also provides tips for preventing health care fraud and lists medical conditions that are often targeted, such as weight loss, cancer, and sexual difficulties.

1. CHAPTER 3
HEALTH FRAUD

2. Chapter Objectives
• Explain health fraud and cite some ways that it is
perpetrated.
• List ways to check on the authenticity of a product or
service.
• Explain quackery and how it is practiced.
• Explain how health care fraud drives up the cost of
health care.
• List ways to prevent health care fraud.

3. Chapter Objectives
• Discuss weight loss fraud.
• Explain steps to assure that a fitness program is right
for you.
• Identify clues to fraud involving chronic conditions
such as HIV/AIDS, diabetes, cancer, and arthritis.
• Explain various scams related to sexual enhancement,
genetic tests, aging, and influenza.

4. Definitions
• Fraud: an intentional act perpetrated to be deceptive
in order to gain something of value.
• Health fraud: services or articles of unproven
effectiveness that are promoted to improve health,
well being, or appearance.
• Health care fraud: an intentional deception or
misrepresentation that an individual or entity makes
knowing that the misrepresentation could result in
unauthorized benefit to the individual, to the entity, or
to some third party.

5. Examples of Health Fraud Practices
• Use of testimonials
• Claims to treat a wide range of conditions
• Claims of “natural” or “all natural” product
• Describes product as a “miracle cure”
• Offers of a money-back guarantee
• Uses meaningless jargon meant to impress
• Claims that the government or the medical
establishment is suppressing the treatment

6. Checking on the Authenticity of a Product
• Talk to a physician, pharmacist, or other healthcare
professional.
• Check with the Better Business Bureau.
• Check with the state Attorney General’s office.
• Check with an appropriate nonprofit group.
• Contact the Food and Drug Administration.

7. Health Quackery
• Definition: promotion of health practices or remedies
that have no compelling scientific basis.
• May or may not be intentional
• May be promoted by physicians or nonphysicians
• May be promoted in almost any medium
• Quacks may be very skillful at deception and
persuasion.

8. Insurance and Health Care Fraud
• Places financial burden on the system, insurers, and
individual subscribers
• Examples:
 Billing for services not provided
 Billing multiple times for the same service
 Dispensing generic drugs and charging for name
brand drugs
 Ordering unnecessary tests and charging for them
 Use of another person’s insurance card

9. Examples of Ways to Prevent Health
Care Fraud
• Guard your personal information, including your
insurance identification number.
• Read your insurance policy and benefit statements.
• Protect your medical records.
• Do not encourage providers to make erroneous
entries on bills or records.
• Do not attempt to maintain a family member on your
policy when that person is no longer eligible.
• Report suspected fraud.

10. Frauds Often Target
• Weight loss
• Fitness
• HIV/AIDS
• Diabetes
• Arthritis
• Cancer
• Sexual difficulties
• Influenza
• Aging
• Genetics testing

11. Combating Health Fraud
• Be informed.
• Know the details of businesses with which you do
business: address, email, telephone number, name of
the person with whom you spoke.
• Be careful about Internet purchases.
• Report fraudulent practices.