New GAO Report Shows Costs, Outcomes of Anti-Fraud Efforts
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.