The recent killing of the United Healthcare CEO has brought renewed attention to the complexities within our health care system. While issues such as care denials and profit prioritization in Medicare and Medicaid plans are valid concerns, there’s another significant problem that often flies under the radar: health care fraud. This isn’t just a minor issue — it’s a billion-dollar challenge that’s raising costs for taxpayers and patients, and impacting the quality and affordability of care for all of us.

Gov. Joe Lombardo in his State of the State speech announced that he wants to create a Nevada Health Authority that would house the Medicaid program. I am optimistic that this new entity could better investigate and reduce health insurance fraud. 

The scope of health care fraud

The Federal Department of Health and Human Services Office of Inspector General recently released some eye-opening numbers for 2024:

• More than $7 billion recovered from fraud investigations and audits
• 1,548 criminal and civil enforcement actions taken against suspected fraudsters
• 3,234 individuals and entities excluded from federal health care programs

These numbers paint a sobering picture: billions in losses and thousands of cases, yet they likely represent only a fraction of the full story. Health care fraud could be a much bigger problem than these numbers show, highlighting just how tricky this issue really is. 

The many faces of health care fraud

Health care fraud is a complex issue that can occur at various levels of the system. While most health care professionals operate with integrity, there are unfortunately some bad actors out there. The consequences extend beyond financial losses:

• Patient safety: Some individuals may undergo unnecessary or potentially harmful medical procedures.
• Resource allocation: Fraudulent activities can divert critical resources away from patients who genuinely need care. 
• System integrity: Instances of fraud can erode trust in our health care institutions and providers.

Nevada’s health care fraud landscape

Health care fraud is happening in Nevada. Consider these cases:

1. In May 2024, a 75-year-old Nevada doctor was convicted of defrauding nearly $2 million from Medicare and Medicaid. He was writing unnecessary prescriptions for patients he’d never seen, then sending them to a pharmacy in Detroit for kickbacks.
2. The case of Silver State Health Services shows how even nonprofits can be involved. Its former CEO, Ryan Linden, is accused of misappropriating more than $340,000 from a federal grant meant for personnel costs.
3. Henrietta Binford from Las Vegas set up a company called Shepherd’s Heart Services and billed Medicaid for more than a $1 million worth of services she never provided. She’s now serving a 10-month prison sentence and ordered to pay restitution. 

These aren’t isolated incidents; they’re symptoms of a much bigger problem that affects health care costs and accessibility for everyone.

On a positive note, our state lawmakers are taking action. On behalf of the Nevada Attorney General’s Office, the Assembly Committee on Government Affairs has introduced AB15 in the 2025 session that aims to give our attorney general more power to investigate and prosecute health care fraud. This targeted legislation demonstrates a growing awareness of the need to combat fraud at every level of governance.

Addressing this billion-dollar challenge requires a multifaceted approach.  We need to invest in advanced data analytics and artificial intelligence to detect fraudulent patterns more effectively. We should train health care providers, insurers and patients to recognize and report potential fraud, as well as encourage cooperation between public and private sectors to share information and best practices.

To make it easier for whistleblowers and concerned citizens to report suspected fraud, we need streamlined reporting systems. Also needed are stricter penalties to deter potential fraudsters.

Supporting bills such as AB15 is a good start, but it’s just that — a start. We need everyone to play a part: policymakers, health care providers, insurers and patients. We all need to be vigilant and speak up when something doesn’t seem right.

There are other bill drafts addressing health care issues at the upcoming legislative session. Hopefully more of them will address the growing issue of fraud that is raising rates for all Nevadans.  

As we continue to grapple with the complexities of our health care system, it’s crucial that we don’t lose sight of the impact of fraud. By pushing for comprehensive reform at state and federal levels, we can work toward a health care system that is not only more efficient and affordable but also more trustworthy and equitable for all.

Dr. Traci Biondi is the chief medical officer for Prominence Health in Reno. She is a board-certified anesthesiologist and received her medical degree from UNR’s School of Medicine.

The Nevada Independent welcomes informed, cogent rebuttals to opinion pieces such as this. Send them to [email protected].