Make The Healthcare System in America Healthy Again

By: Richard Gengler, Founder and CEO of Prevail Health


The announcement that over $900 million in false billing for government health programs calls for more attention from our nation. With nearly 20% of America’s gross domestic product now being spent on healthcare, and this number outpacing the economic growth each year, it is easy to see how so much fraudulent activity could be taking place.

In one of the largest crackdowns of fraudulent activity ever, the Department of Health and Human Services Secretary Sylvia Mathews Burwell announced the sweep in 36 federal districts. The result was over 300 charges against individuals, including over 60 doctors, nurses, and licensed health professionals.  This is the largest takedown ever both in the amount of dollars as well as the number of defendants.


The various crimes that were charged include “conspiracy to commit health care fraud, violations of the anti-kickback statutes, money laundering, and aggravated identify theft.”

“As this takedown should make clear, health care fraud is not an abstract violation or benign offense – It is a serious crime,” said Attorney General Lynch.

So much of the inefficiencies in the system seem to stem from the fact that people are continuing to feel as though they are dealing with others people’s money. Is it really other people’s money? Taxpayers are funding the increasing budgets at the Centers for Medicare & Medicaid Services (CMS). Where is the accountability and use of technology to better facilitate transparency effective use of funds?

This pales in comparison to the reportedly $80 billion misspent on Medicare and Medicaid in 2014, with a majority being spent on the traditional fee-for-service programs. The Government Accountability Office (GAO) report indicates much of the misspent money in Medicaid is coming from the managed care portion of the care.

When the lines between health and economic profit become blurry, it seems there is danger on the horizon. The doctors and ones leading traditional health practices are incentivized to push for as much service—whether needed or not—to maximize profit. What if there was a different way to provide access to desperately needed health services, improving the quality of care, and reduce overall healthcare spending?

The response from Secretary Burwell should cause some questioning from the general public. Her response? Utilize $350 million from the Affordable Care Act dedicated for health care fraud and prevention.

This is all taking place as the health of our nation continues to decline, outcomes are worsening, and spending continues to increase particularly compared to other countries. The time is clearly now to utilize one of the best things that America has going for it – our innovative entrepreneurs developing solutions for difficult, big, real-world problems. It is great for politicians to support innovation, however should the innovative ideas they are supporting be the next app to order a meal to your door, or one that increases access to needed healthcare that is clinically proven to take a chunk out of the 20% of GDP spend? Should leaders get behind and support an innovative solution that optimizes our nation?

I applaud the efforts of politicians such as Representative Tim Murphy of Pennsylvania and Senator Brian Schatz of Hawaii who are striving to be leaders in one of the most urgent problems facing our country. As our recent publication in the Society of Actuaries piece was titled, “Mental Health Enables Wealth.”

Let’s work together for a healthier, and thus more prosperous nation! Wishing you, your family, and your friends the very best over this holiday weekend when we celebrate how great our nation is.

I firmly believe that together anything is possible!