What we see and what we do not see in health care

What we see and what we do not see in heath care Fourteen years ago, US Inspector General and the Department of Health and Human Services conduced a detailed analysis of money outflow from the Medicare and Medic-aid federal health care programs; their findings shocked the nation: US $23 billion was lost annually to different forms of fraud and corruption, reaching 14% of the total health budget for both federal programs (1). This criminal activity, formally termed 'white-collar fraud, ' was carried out through spectacular operation of falsifying and 'building up' of invoices, opening of false firms, insurance fraud, charging non-existent laboratory and other tests, and other fairly complicated but extremely lucrative criminal ventures. Only a year after the first report, the amount lost to health care programs dropped to US $20.3 billion and to US $12.6 billion after two years (1), which can be ascribed to continuing analysis and money flow control, as well as detection and processing of fraud cases. Malcom Sparrow's book License to Steal provides an analysis of the ways used to bleed money from the health care system and reveals a lucid truth: " What you see is not a problem. What you don't see creates a serious damage to the system , and the effectiveness of the control mechanisms is measured by how many invisible problems they discover and prevent. " Sparrow detected another appalling phenomenon in health care – that many criminal groups, until recently concentrated on drug smuggling and other serious criminal deeds, have been redirecting their activities to health care fraud for two simple reasons – because it brings enormous monetary return and because the punishment for the acts, if they are discovered, are much more lenient than in 'conventional' street or organized crime. Sparrow also states that, because the types of fraud employed are ingenious, an important task for the health care management is to develop a good control system so that the theft from the taxpayers and damage to the quality of the health care are reduced. Fraud and corruption in the public health care is recognized at the global level and is perhaps the biggest contemporary challenge to the financial management in health care. I write this in regard to the Medikol scandal that has been raging in Croatia, and has been branded by the media as " the biggest affair of Croatian health care. " The essence …