Will retiring baby boomers create a fraud spike?

As the baby boomer generation transitions into retirement, the resulting influx of seniors may lead to an increase in fraud, according to an article published by the Coalition Against Insurance Fraud.

Older adults are heavily represented in America's prisons, where many are serving time for fraud. And recidivism in this age group is high, the article added.

"Cynicism over lost investments, failure to save properly and declining home values also could incline many seniors to turn to fraud. Still, the insurance industry has yet to fully understand, study and respond to the boomer bulge as a looming fraud phenomenon. At stake are potentially many millions of dollars lost to boomer scams unless the fraud-fighting community determines the potential scope of the problem and its needed responses," the article noted.

Some payers have given older people an investigative "free pass" based on the assumption that seniors are honest, conservative and unlikely to commit fraud. But "the vast size of this demographic suggests a potential fraud trend in absolute numbers," the article noted.

Moreover, data continue to demonstrate that many older adults retain the criminal habits of their youth. And when people believe they can cheat insurers with impunity, they're more apt to behave dishonestly, the article added. "Even many normally honest seniors may feel financially pressured enough to view insurance fraud as a convenient and low-risk income supplement," the Coalition noted.

Yet government enforcement actions demonstrate vigorous federal response to healthcare fraud committed or enabled by older adults, whether they're patients or providers.

Recent cases in point: A baby boomer was among four Medicare beneficiaries indicted last week for accepting illegal kickbacks to take medically unnecessary ambulance trips in the Philadelphia area. And Elsa Capo--a petite, 71-year old grandmother--was indicted for taking kickbacks for allowing her Medicare number to be used in a home healthcare scam. She received three years of probation along with a home detention period, AARP Bulletin reported.

For more:
- here's the Coalition Against Health Insurance Fraud article
- read the AARP Bulletin article

Suggested Articles

The HHS OIG is asking for an additional $23.7 million to support fraud oversight that has benefited from an emphasis on data analytics.

A New York surgeon was sentenced to 13 years in prison for fraud and more physician practice news from around the web.

A federal judge has ruled that the U.S. government’s remaining fraud case against UnitedHealth can move forward.