GAO: Hospitals Most Common Subjects in Civil Healthcare Fraud Investigations
Written by Molly Gamble | October 10, 2012Tags: civil fraud cases | DOJ | GAO | healthcare fraud | HHS | hospitals | investigations | Medicaid fraud | Medicare fraud | OIG
Hospitals and medical facilities made up more than one-third of the subjects in civil fraud investigations in 2010, making these facilities the most frequent type of subject, according to a new report from the U.S. Government Accountability Office.Roughly one-third of the 2,339 subjects of civil fraud investigations conducted by HHS' Office of Inspector General and the Department of Justice were hospitals and medical facilities, with the latter encompassing medical centers, clinics or practices. In 2010, 35 percent more subjects were investigated for civil fraud compared with 2005. About half of the subjects who were investigated were pursued. Of the cases pursued, 55 percent resulted in judgments or settlements.
For criminal cases, medical facilities or durable equipment suppliers made up 40 percent of the subjects. Most of the subjects were in cases that were not referred for prosecution, however. Of those that were pursued, most subjects were found guilty or pled guilty or no contest.
In total, 10,187 subjects were investigated for healthcare fraud in 2010 — 7,848 for criminal fraud and 2,339 for civil fraud.
More Articles on Hospitals and Healthcare Fraud:
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The number of investigations by both the Office of Inspector General (OIG) and of Center for Medicare Services (CMS) is going up dramatically. This is going to put pressure on hospitals to ensure all their data is fully accurate and up to date at all times. Gone are the days when estimations and suppositions for billing and documentation would work. Today and in the future, hospitals and other healthcare providers must have good systems and processes in place to ensure accurate information is being captured as care is given.
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