In a report released Tuesday, the Government Accountability Office outlined the costs and outcomes of state and federal efforts in 2010 against health care fraud, Modern Healthcare reports.
Breakdown of Fraud Cases
The report, which was based on analyses of data from 10 state anti-fraud units, found that:
- Medical centers, clinics and practices were involved in nearly 25% of the 7,848 criminal fraud cases that year;
- Durable medical equipment suppliers accounted for about 16% of the cases; and
- Hospitals accounted for fewer than 5% of cases.
Meanwhile, GAO reported that hospitals were the subjects of about 20% of federal civil fraud cases, of which about 18% involved separate medical facilities, according to Modern Healthcare.
Home health care providers and health care practitioners accounted for more than 40% of the 2,742 subjects that were investigated for fraud in 2010 among reviewed cases in Medicaid and CHIP, GAO found.
Details of Anti-Fraud Expenses, Recouped Costs
State Medicaid anti-fraud efforts in 2010 resulted in nearly $829 million in judgments and settlements, with pharmaceutical companies paying more than 60% of the total, according to GAO.
The report found that the federal government in 2010 spent at least $608 million fighting fraud in Medicare and Medicaid. It is unknown how much additional funding states spent on anti-fraud efforts in their Medicaid programs.
In addition, the report found that the HHS Office of Inspector General in 2010:
- Conducted about 8,900 investigations -- nearly 2,800 more than in 2005 -- resulting in nearly $960 million in fines or restitution; and
- Excluded nearly 2,200 individuals from future participation in Medicare, 60% of whom were nurses.
Senate Health, Education, Labor and Pensions Committee Chair Tom Harkin (D-Iowa) said the report underscores the "excellent work" of investigators targeting health care fraud and highlights the need for continued investments in anti-fraud efforts. He added, "These investments provide a significant return, protecting taxpayer dollars, weeding out bad actors and improving quality of care for beneficiaries" (Daly,
Modern Healthcare, 10/9).