Gov. Watchdog: Health Care Fraud is Out of Control

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March 4, 2016—Health care fraud, the Government Accountability Office (GAO) reports, is a serious problem. During a recent podcast interview released by the government’s own watchdog agency, the director in GAO’s health care team Kathleen King talked about the agency’s recent research into the matter.

During the research, GAO “combed through hundreds of court orders to identify health care fraud schemes.” The review of 2010’s 739 health care fraud cases produced the following results:

About 68 percent of fraud cases involved more than one scheme. At least 61 percent were tied to two, three, or even four schemes, and about 7 percent involved five or more schemes.

About 43 percent of cases involved fraudulent billing, such as billing for medical services that were never provided. At least 25 percent of cases involved billing for services that were not medically necessary.

About 25 percent of cases involved the falsification of records to support a fraud scheme, 21 percent were tied to participants being paid kickbacks in said schemes, and about 21 percent involved the purchase of controlled substances or misbranding prescription drugs in a fraudulent way.

In 62 percent of the cases, providers were complicit, while beneficiaries were complicit in 14 percent of the cases.

According to GAO, the use of “smart cards” could have only prevented 22 percent of the cases. The vast majority of fraud cases (78 percent) would not be affected by the use of the technology.

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Would a reform of the laws revolving around health care benefits be enough to fix this problem? Comment below.

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