매년 헬스케어와 관련된 사기 및 실수로 전세계적으로 약 1천800만유로(약 2천600억 달러)의 손실이 발생하고 있다는 로이터 통신의 보도입니다.

유럽 헬스케어 사기 및 부패 네트워크(EHFCN)와 영국 포츠머스 대학의 사기 서비스 방지센터(CCFS)의 공동연구 결과에 따르면,  전세계 의료 지출의 5.59%가 실수나 부패로 소모되고 있다고 합니다.

연구논문의 공동저자인 유럽 헬스케어 사기 및 부패 네트워크(EHFCN)의 폴 빈크(Paul Vincke) 대표는 “사기나 부패로 잃게 되는 유로(돈)는 (치료를) 필요로 하는 누군가가 어디에선가 적절한 치료를 받지 못하고 있다는 것을 의미한다.”고 밝혔습니다. 

아울러 그는  ”(치료를 필요로 하는) 사람들을 더 오래 앓게 만들며, 사람들의 생명을 불필요하게 앗아가기도 한다. 헬스케어 사기는 살인행위!라는 사실을 똑똑히 알아야 한다.”고 얘기했습니다.

이번 연구는 영국, 미국, 뉴질랜드, 프랑스, 벨기에, 네덜란드 등 6개국의 33개 기관의 69개  집행사례(exercises)를 분석한 것이다.

연구 보고서에서는 약사가 한 건의 처방을 여러 건으로 나누어서 추가적인 비용을 청구한 경우, 제약회사가 약품가격 카르텔을 형성한 경우, 의사가 여행경비를 요구하거나 정부승인을 남용한 경우, 환자가 사기성 보험청구를 한 경우 등 각양각색의 헬스케어 사기 사례를 밝히고 있습니다.

2명의 의사는 정부에 병원시설 개선 지원금을 청구하여 자동차 수출입 회사를 설립하는데 지원금을 사용하기도 했습니다. 

톰슨 로이터(Thomson Reuters)는 2009년 10월 미국의 헬스케어 시스템은 해마다 5천50억$~8천500억$를 낭비하고 있으며, 이중 약 22%는 보험 사기, 불필요한 서비스, 기타 사기행위에 의한 것이었다고 보도하기도 했습니다.

로이터통신의 보도 원문은 아래와 같습니다.

=================================

Global healthcare fraud costs put at $260 billion

By Kate Kelland, Health and Science Correspondent Kate Kelland, Health And Science Correspondent

출처 : 로이터(Reuters) 통신, 2010년 1월 18일
http://news.yahoo.com/s/nm/20100118/hl_nm/us_healthcare_fraud_3

LONDON (Reuters) – Some 180 billion euros ($260 bln) is lost globally every year to fraud and error in healthcare — enough to quadruple the World Health Organisation’s and UNICEF’s budgets and control malaria in Africa, experts said on Monday.

A study by the European Healthcare Fraud and Corruption Network (EHFCN) and the Center for Counter Fraud Services (CCFS) at Britain’s Portsmouth University found that 5.59 percent of annual global health spending is lost to mistakes or corruption.

“Every euro lost to fraud or corruption means that someone, somewhere is not getting the treatment that they need,” said Paul Vincke, EHFCN’s president and one of the report’s authors.

“They are ill for longer, and in some cases they simply die unnecessarily. Make no mistake — healthcare fraud is a killer.”

The report reviewed 69 exercises in 33 organizations in six countries to measure healthcare fraud and error losses.

The combined expenditure assessed was more than 300 billion pounds ($490 bln) and the experts extrapolated their findings from Britain, the United States, New Zealand, France, Belgium and the Netherlands to get a global picture.

Data from developing nations would not have changed the global figure, the authors said, but were hard to come by, since the study included only exercises based on statistically valid samples with measurable levels of accuracy.

The report found evidence for many different types of fraud, from pharmacists dividing prescriptions into small packages to claim extra fees, to drug companies organizing price cartels, to doctors over claiming travel costs and abusing government grants, to patients making fraudulent insurance claims.

Two doctors were found to have claimed a government improvement grant for their clinic which they then spent on setting up a car import-export business.

RANGE OF SCAMS

A Thomson Reuters report published last October found that the U.S. healthcare system wastes between $505 billion and $850 billion every year, with around 22 percent of that going on fraudulent insurance, kickbacks for referrals for unnecessary services and other scams.

The World Health Organization’s latest estimate of global healthcare expenditure was $4.7 trillion (3.3 trillion euros). The fraud report’s 260 billion loss figure is based on an average of 5.59 percent of spending being lost to fraud.

Jim Gee, chair of the CCFS, said Monday’s report proved it was possible to measure the nature and extent of losses to fraud and error, and this was vital to tackling the issue.

“It may be embarrassing for some organizations to find out just how much they are losing,” he said in the report.

“Because of the direct, negative impact on human life of losses to fraud, it is never easy to admit they take place.”

But Gee said the first step to combating fraud was for governments and institutions to stop “being in denial” about it.

“If an organization is not aware of the extent or nature of its problem, then how can it apply the right solution?”

The European Healthcare Fraud and Corruption Network (EHFCN) was set up to help the region’s healthcare organizations find and cut losses on fraud and error so that more money could be better spent on patient care.

Similar networks exist in the United States and Canada