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GAO Report: Hospitals and Medical Facilities Most Frequent Subjects of Criminal and Civil Healthcare Fraud Cases

Posted in Healthcare Services Investing

A new Government Accountability Office report analyzing 2010 data shows hospitals and medical facilities (e.g., medical centers, clinics and medical practices) were the most frequent subjects of civil healthcare fraud cases, while medical facilities and durable medical equipment suppliers were the most frequent subjects of criminal fraud cases in 2010.

According to the data, 10,187 subjects were investigated for healthcare fraud in 2010, of which 7,848 were subjects of criminal fraud cases and 2,339 were subjects of civil fraud cases.

About 49 percent of criminal healthcare fraud subjects were, or were affiliated with, medical facilities, durable medical equipment suppliers and home health agencies. Of the subjects associated with criminal cases, about 1,100 were charged, and 85 percent of those charged were found guilty, pled guilty or pled no contest.

Nearly 20 percent of civil healthcare fraud subjects were hospitals and 18 percent were medical facilities. Fifty-five percent of civil cases resulted in a judgment for the government or in a settlement. For those cases that resulted in a judgment and/or settlement, about 44 percent of the subjects were hospitals and medical facilities.

Cracking down on healthcare fraud remains a significant focus of the Department of Health and Human Services’ Office of the Inspector General (OIG) and the Department of Justice. Earlier this week, the Medicare Fraud Strike Force charged 91 medical professionals for allegedly participating in Medicare fraud schemes involving nearly $430 million in false billing. We have also observed a renewed commitment by OIG to anti-fraud enforcement efforts and expect to continue to see fraud as a focus of its Work Plan.