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GAO Reports on Health Care Fraud

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GAO Reports on Health Care Fraud

October 11, 2012

The U.S. Government Accountability Office (GAO) has released a report examining the types of providers involved in Medicare, Medicaid and Children's Health Insurance Program (CHIP) fraud cases. GAO found that medical facilities and durable medical equipment suppliers were investigated most frequently for criminal fraud, while hospitals and medical facilities were investigated most frequently for civil fraud.

Data from one year of the study show that 85 percent of criminal cases investigated were not referred to the Department of Justice for prosecution. Conversely, approximately half of civil cases were pursued, of which a slight majority resulted in judgments or settlements. Home health care providers comprised close to 40 percent of criminal convictions in one year looked, and in 2010, judgments and settlements pursued by state Medicaid Fraud Control Units totaled nearly $829 million.