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Healthcare fraud cases hit record high

Teresa Tanoos's picture
Prosecutors file record number of healthcare fraud cases

Federal prosecutors filed a record number of healthcare fraud cases in the last fiscal year, up nearly 10 percent since 2004, according to the Transactional Records Access Clearinghouse (TRAC).

TRAC, a nonprofit group from Syracuse University that keeps records of federal spending, used the Freedom of Information Act to acquire data from the Department of Justice (DOJ), which revealed 377 cases of healthcare fraud. That’s the largest number of such cases filed in a year since the passage of the federal Health Care Fraud law.

TRAC co-director Susan Long told the AP that these record numbers suggest the FBI and the Department of Health and Human Services are stepping up their efforts against healthcare fraud, an area that she also said the Obama administration “is not ignoring.”

According to the DOJ data, the FBI led 46.4 percent of the last fiscal year’s federal healthcare fraud prosecutions, with the HHS taking the lead in 36.6 percent of the cases, although many of these fraud cases actually originated with the HHS before being handed over to the FBI.

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The data also revealed that the largest annual increase in the rate of prosecutions over the years was 1200 percent in the Southern District of Illinois, while the Eastern District of Missouri had the greatest decrease in federal healthcare fraud prosecutions at 30.8 percent.

Meanwhile, Southern Illinois U.S. Attorney Stephen Wigginton told the AP that prosecutors can choose which crimes they want to fight, and that he will be paying particular attention to cracking down on healthcare fraud.

In addition to a record number of federal healthcare fraud cases filed by prosecutors, this year has also seen an exceptional number of civil fraud recoveries. During the last fiscal year alone, the justice department regained a whopping $3.8 billion from fraud cases against the government that were filed in civil courts.

According to the FBI, healthcare fraud is costing the United States an estimated $80 billion a year. Moreover, the threat of rising costs is growing, with national health care spending topping $2.7 trillion while expenses are continuing to outpace inflation. Recent cases also show that medical professionals are more willing to risk patient harm in their schemes.

1. Transactional Records Access Clearinghouse (TRAC), TRAC Reports: Prosecutions of Health Care Fraud Law Reach New High in FY 2013, January 14, 2014.
2. Department of Justice (DOJ), Press Release: Departments of Justice and Health and Human Services Announce Record-Breaking Recoveries Resulting from Joint Efforts to Combat Health Care Fraud, February 11, 2013.
3. Federal Bureau of Investigation (FBI), Health Care Fraud: Rooting out health care fraud is central to the well-being of both our citizens and the overall economy, last modified on April 1, 2013.