government
Medical facilities top the list of criminal health fraud investigations
NEWS IN BRIEF — Posted Oct. 22, 2012
The Government Accountability Office reported that medical centers, practices and clinics as well as durable medical equipment suppliers were the entities most frequently investigated for criminal health care fraud cases involving public insurance in 2010.
In researching which health care professionals most often were involved in health care fraud cases, the watchdog agency found that nearly 10,200 individuals and entities had been investigated in these cases, including those involving potential fraud activity in Medicare, Medicaid and the Children’s Health Insurance Program.
“Many of the 7,848 criminal subjects in 2010 were medical facilities or durable medical equipment suppliers, representing about 40% of subjects of criminal cases,” the report found. Of those cases pursued, most of the subjects either pleaded guilty or no contest, or were found guilty.
Medical facilities and hospitals were the entities most often investigated for civil fraud cases. About half of these cases were pursued in 2010, and 55% resulted in judgments or settlements, the GAO report stated.
Of the 2,742 entities investigated just for health care fraud in Medicaid and CHIP in 2010, more than 40% were health care practitioners or home health care professionals.
Note: This item originally appeared at http://www.ama-assn.org/amednews/2012/10/22/gvbf1022.htm.
