FBI, FCLB -- Working Together

By Editorial Staff

In his keynote address to the Federation of Chiropractic Licensing Boards (FCLB), FBI Supervisory Special Agent Rick D. Germroth made it clear that the Bureau's investigations into health care fraud were on the rise. In fact, the FBI's National Health Care Fraud Unit is becoming a separate unit.

The FBI estimates that health care fraud costs the United States $50-70 billion annually. He stated that three to five percent of all health care claims include some element of fraud. The problem has become so immense that unscrupulous health care providers are being referred to as the "medical mafia."

Of the total dollars spent on health care in the U.S., it is estimated that 80 percent are legitimate, 15 percent questionable, and 5 percent fraudulent. Even the institution of national health care will not curb health care fraud.

Health care fraud is said to have three components. To commit health care fraud, a person must:

act knowingly
intend to deceive
reap financial gain

Agent Germroth's presentation demonstrated examples by all health care professionals, including one chiropractor. The two most elaborate examples involved MDs and pharmacists.

The FBI has recently reassigned 50 agents to the National Health Care Fraud Unit. This brings the number of agents assigned specifically to health fraud to a total of 150. In addition, there are another 400 agents that work in some aspect of health care fraud.

In the past 12 months, the Bureau has trained over 800 agents, prosecutors and investigators in the area of health care fraud. This has become a major concern for the nation as it wrestles with the problem of making health care available to all.

The FCLB and the state licensing boards it represents have been asked by the FBI to assist and alert the Bureau in cases involving chiropractic health care fraud. Brent Owens, DC, immediate FCLB past president sees it this way:

"I feel the FBI presentation pointed out clearly that chiropractic is no more or less a target than any other health care industry. There is a consensus at this conference that the state boards will take more aggressive action when fraudulent activity is suspected. The FBI is willing and able to apply their resources to assist the licensing boards in investigating complex cases.
"This is the beginning of a very productive working relationship with the federal government in partnership with the state licensing jurisdictions to tackle this difficult problem with health care fraud. In view of the sometimes limited means available to state licensing boards, they might find it both appropriate and necessary to call in federal resources to assist in the investigation and prosecution of offenders. We in chiropractic have a responsibility to the profession to weed out those 'bad apples' who have jeopardized our relationship with third party payers and the public. By doing this I feel we will elevate the profession to a more credible stature."