Fraud and Abuse

Implementation Briefs

HHS Office of Inspector General’s Top Management and Performance Challenges for Fiscal Year 2010

Categories: Department of Health and Human Services, Fraud and Abuse, Key Developments, Office of Inspector General

Posted on March 18, 2011

The complexity and size of the U.S. health care system makes it susceptible to fraud and abuse in both the public and private insurance markets. According to the National Health Care Anti-Fraud Association (NHCAA), an estimated 3% of all health care spending is lost to fraud; government and law enforcement agencies have estimated fraud-related loses to be as high as 10% of annual health care expenditures. The financial ramifications of these fraudulent schemes are enormous to patients, providers and the federal government. Indeed, the U.S. Government Accountability Office (GAO) estimates that for 2010, Medicare alone had $48 billion in improper payments (underpayments and overpayments). In response to its findings, the GAO recommended that the Centers for Medicare and Medicaid Services find ways to address the vulnerabilities to improper payments and enhance program integrity.

Fraud and Abuse: Revisions to Anti-Kickback Statute

Categories: Fraud and Abuse

Posted on May 20, 2010

The health reform law revises the anti-kickback statute to broaden the reach of the law and enhance enforcement.