• Molly Knobler

Why Combatting Healthcare Fraud Is Getting More Important

By Molly Knobler & Talia Mermin of Phillips & Cohen, LLP

For fiscal year 2021, $1.2 trillion was allocated to Medicare (which in 2019 covered more than 58 million people). By 2028, Medicare expenditures are projected to reach $1.56 trillion (to cover approximately 75 million people).


There are a number of drivers of this growth, but the primary one is the anticipated growth in Medicare enrollment. Among major payers, Medicare is expected to experience the fastest spending growth, largely as a result of having the highest projected enrollment growth.


According to projections by the Congressional Budget Office, healthcare costs will continue to account for a steadily growing share of the economy, reaching 37 percent of GDP by 2050 and 46 percent by 2080.


These costs—and enrollment—will only increase if the age of Medicare eligibility is lowered to 60, as has recently been proposed. The cost will also increase if the proposed expansion of Medicare to cover vision, dental, and hearing expenses becomes law.


As Medicare enrollment and spending goes up, the need for effective tools, like the False Claims Act and its whistleblower provisions, to combat healthcare fraud only increases.