Source: US Department of Justice
Photo Source: Unsplash,
Annotation After identifying the characteristics of health care fraud, this article discusses the role of law enforcement agencies in the investigation of such fraud as well as punitive actions.
Abstract Fraud encompasses clear and distinct activities by practitioners and business persons in the health care field to make money illegally, primarily by bilking patients, private insurers, or the Federal Government. For the most part, the audit system established by the various Federal and State regulatory agencies do not detect this type of criminal activity. Federal, State, and local law enforcement all must play a role in combating health care fraud. Success in curtailing the activities of fraudulent health care providers depends on closely coordinated efforts of the entire criminal justice community. Several Federal agencies devote extensive resources and a vast number of hours to health care fraud investigations. These include the Drug Enforcement Administration, the Food and Drug Administration, the U.S. Postal Service, the Department of Health and Human Services, the U.S. Department of Labor, the Office of Personnel Management, and the Defense Criminal Investigative Service. The FBI's national strategy against health care fraud takes a holistic rather than parochial view of health care fraud. Single defendant prosecutions have given way to multi-defendant conspiracy indictments. Forty-two States operate special Medicaid Fraud Control Units. These units are the front line in Medicaid fraud enforcement and can provide relevant information to local agencies or work with them to conduct undercover operations. When local allegations surface, local law enforcement agencies can conduct an investigation or notify the appropriate State or Federal agency of possible fraud and patient abuse problems within their jurisdictions. Since individuals convicted of health care fraud rarely serve significant time in jail (because most are viewed as first- time offenders), asset forfeiture is often the only form of punishment applied. 6 notes
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