A tale of two healthcare systems
Corporate fraudsters regularly pillage the US healthcare system. Now Britain’s NHS is in their sights.
Fraud accounts for up to 10 per cent of total US healthcare expenditure, or about US$350 billion, of the annual US$3.54 trillion that Americans spend on healthcare, according to the Federal Bureau of Investigation.
In recent months, AmerisourceBergen, one of the world’s biggest pharmaceutical distribution companies, and UnitedHealth Group, the largest provider of subsidised private medical insurance for the elderly, have featured in fraud scandals in the United States.
AmerisourceBergen was fined US$260 million by the US Food and Drug Administration for emptying pre-filled glass syringes of expensive cancer drugs and reloading the
drugs, in slightly smaller doses, into cheap plastic syringes before distributing them to oncology centres.
For years, the company allegedly pocketed the profits obtained by creating and selling 10 per cent more pre-dosed syringes in this manner.
Prosecutors claimed that because the refilling process was not conducted under sterile conditions, it led to ‘floaters’ and bacterial contamination, putting at risk the health of thousands of cancer patients with compromised immune systems.
UnitedHealth Group is accused of overcharging the US government more than US$1 billion, by claiming patients were sicker than they actually were.
The Justice Department has filed a lawsuit against UnitedHealth Group based on evidence from a whistleblower.
Meanwhile, Britain’s Conservative government is pushing to privatise and outsource parts of the National Health Service (NHS).
The scale of medical fraud in Britain is still small by comparison, but some of the companies that have paid huge fraud fines in the US – including UnitedHealth, McKesson, Celgene and the Hospital Corporation of America – are becoming increasingly involved in NHS privatisation schemes, writes journalist Dave Lindorff in the London Review of Books.
Fraud grows apace with privatisation
Lindorff quotes Mark Button at the University of Portsmouth as saying that fraud in the NHS is growing apace with privatisation.
“If you give organisations and individuals a situation where there are opportunities to increase fees and revenues through fraud, you’ll get more fraud,” Button says.
“The other problem is that a government that has an interest in promoting marketisation isn’t interested in exposing that fraud.”
Lindorff, an American, found himself increasingly short of breath while holidaying in the British city
A GP found he had a blood oxygen reading of only 91 per cent, fluid in one lung and swelling in his ankles and referred him to the ambulatory assessment unit of a public hospital.
“After years of negative articles in the US media about overworked doctors, cursory exams and brusque support staff, I wasn’t expecting wonders from the NHS. But my experience was quite the opposite,” Lindorff wrote.
Care before profit
He received prompt, careful treatment from doctors, nurses and other staff who treated him with courtesy and patience.
After five days, the hospital brought Lindorff’s blood oxygen level back up to 98 per cent so he could safely fly home to Philadelphia to be seen by specialists there.
“The only mention of payment came when an administrator arrived in the waiting room on the second day and politely asked for my passport number and insurance card, ‘if you have insurance’.”
Lindorff was covered by a US insurance policy that did not accept NHS billing codes but nevertheless he did not receive a bill.
“I shudder to think what would happen to a British tourist without excellent travel insurance suffering a similar health crisis in the US.”
Even in a US public hospital, he says, some-one with no insurance might only be stabilised and sent away.
“The cost of my NHS care, if provided in the US, would easily have topped £10,000, I’m told, assuming it could have even been provided on an outpatient basis as in Oxford.
“For inpatient treatment the bill could easily be treble that.”