Gaming The System

A Retired Judge often complained to me about parties “gaming the system.” She- keen on this issue- authored a well-respected treatise. Her text addressed a Health Care System plagued with controversy. In the United States, there are a number of Health Care Systems. These include Medicare, Medicaid, and Workers’ Compensation. All of these systems are vulnerable to exploitation. One means of doing so is “gaming the system.”

“Gaming the system” is “to exploit or manipulate the rules for a certain system to one’s advantage.” Grammarist. Gaming degrades systems. There are a large variety of systems that are prevalent within societies. Criminal justice, health care, public transportation, and public education are examples of systems. “Gaming the system” can be as simple as “hopping the turnstile” to get onto a subway car. It could as sophisticated as falsifying school test scores in order matriculate students.

Substantially funded, Health Care is one of the more attractive systems to be “gamed.” The large amounts of cash flowing through it make them an enticing target for scammers. Health Care Systems – benefit delivery apparatuses- continually pay out massive sums of money to providers and vendors. Doctors, hospitals, durable medical equipment providers, and pharmacies are all paid. Patients may even receive reimbursements.

The sport of basketball offers up a recent example of “gaming the system.” Professional athletes were accused of taking advantage of their association’s health care system. Associated Press. As a result, the NBA’s Health and Welfare Benefit Plan paid out $3.9 million in bogus charges. This scheme occurred over a three year period.

The criminal indictment told of eighteen former NBA players and others who alleged received about $2.5 million in fraudulent proceeds. AP. They were accused of submitting bogus reimbursements for medical and dental procedures. According to the indictment, chiropractic, wellness clinics, and dental offices’ billings were the fake charges. AP Each defendant made between $65,000 to $420,000.

The amount of this fraud is a fraction compared to other health care frauds. In 2025, in Arizona, two individuals plead guilty to a scheme in which 1.2 billion dollars of false and fraudulent claims were submitted to Medicare. http://www.justice.gov

Conclusion

The Health Care Industry’s stark reality is that every part of the system is vulnerable to fraud. Bad players in the industry are not simply the CEOs of Health Insurance Corporations. Problematic players exist within every juncture of the system. Some of these bad players, in this incident, ironically, were serviceable NBA players. They included the self-proclaimed “Kobe stopper” as well as the “Big Baby” of Celtics’ fame.

In sum, doctors, hospitals, patients, and those working for the particular Health Insurance, i.e. adjusters, are all capable of exacting fraud upon the system. This fraud increases both the cost and the bureaucracy – red tape- and plague consumers. Until a comprehensive plan addressing fraud is imposed and enforced, Health Care Systems will never be cured of their infirmities.

Be well!!

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