GAO Issues Report on Health Care Fraud and Abuse Investigations

The Government Accountability Office (GAO) recently issued a report on providers involved in Medicare, Medicaid, and Children’s Health Insurance Program fraud cases in 2010. According to the GAO, 10,187 providers were investigated for health care fraud in 2010, compared to 2,800 in 2005. The recent investigations included 7,848 individuals and entities for criminal charges and 2,339 for civil charges. The GAO noted that medical facilities and durable medical equipment suppliers faced the highest number of charges for criminal fraud. In relation, hospitals and medical facilities were involved in the largest number of civil fraud cases. The investigations led to approximately 2,200 provider exclusions by the Department of Health and Human Services. Notably, nursing professionals accounted for 60 percent of excluded individuals. The GAO report also included data from 10 Medicaid Fraud Control Units (MFCUs). The MFCU data demonstrated that home health care providers had the highest amount of criminal and civil fraud cases. Overall, the 10 MFCUs recovered $829 million from civil fraud cases. The GAO report is available at: http://www.gao.gov/assets/650/647849.pdf.

“Types of Providers Involved in Medicare, Medicaid, and the Children’s Health Insurance Program Cases.” September 2012. GAO-12-820. Government Accountability Office. 12 Oct. 2012. <http://www.gao.gov/assets/650/647849.pdf.>

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Ms. Shuman assists health care organizations to develop, implement and evaluate their compliance programs and HIPAA privacy programs. Ms. Shuman specializes in our firm’s HIPAA Privacy services, including leading privacy investigations, breach risk assessments, breach notification letters, breach reporting to the Office for Civil Rights and corrective actions plans. She specializes in serving as Interim Privacy Officer for large health care systems, managed care organizations, comprehensive cancer center and health care business associate.