Health Care Fraud

Publication Date: October 2009

Publisher: George Washington University Medical Center School of Public Health and Health Services, Department of Health Policy; Robert Wood Johnson Foundation

Author(s): Scott. Stifler; Nancy. Lopez; Sara. Rosenbaum

Research Area: Health

Type: Report

Abstract:

An analysis published by the George Washington University School of Public Health and Health Services, Department of Health Policy, in collaboration with the National Academy for State Health Policy, finds that health care fraud poses a major challenge in both the private and public insurance sectors and recommends policies aimed at assuring uniform and transparent measurement and reporting of fraud across all forms of coverage.

"A critical problem under current policy is the absence of ongoing and reliable fraud estimates similar to those available in the case of public health insurers," said lead author Sara Rosenbaum, Harold and Jane Hirsh Professor of Health Law and Policy and Chair of the Department. "As a result, it is difficult to fashion consistent policies to address fraud, a critical component of health reform."

The report, Health Care Fraud, also finds that fraud information related to public programs is frequently confused with payment error data. "While payment errors represent a major area for program improvement," Rosenbaum notes, "it is essential to separate such errors from actual instances of fraud, since the two problems call for distinct corrective strategies."

The report is issued as Congress considers steps to strengthen the tools and resources available to law enforcement to investigate and prosecute fraud, and as states focus increased attention on this problem.