Healthcare fraud cases dip to 18-year low

Although healthcare fraud continues to be a major problem, 2016 is projected to have the lowest level of federal prosecutions for healthcare fraud since 1998, according to a report conducted by the Transactional Records Access Clearinghouse (TRAC).

During the first six months of fiscal year 2016, there have been a total of 239 healthcare prosecutions, on pace for a total of 478 for the fiscal year. This projection represents a 23.2 percent decline from 2015 when there were 622 total charges.

According to case-by-case information obtained by TRAC under the Freedom of Information Act from the Executive Office for United States Attorneys, there has been a decline from 1,235 prosecutions (61.3 percent) five years ago. Overall prosecutions are down from 528 (9.5 percent) in 2006.

The top leading investigative agencies this year that have persecuted these charges are the Health and Human Services (49.4 percent), the Federal Bureau of Investigation (31.8percent), the Defense Department (3.3 percent) and the Drug Enforcement Agency (2.5 percent).

According to TRAC, the top leading charges recorded in the prosecution with the U.S. District Court in the first six months of 2016 are “Healthcare Fraud," “Mail fraud –Attempt and Conspiracy” and “False claims relating to health care matters."

Among the top 10 charges analyzed by TRAC, the charge that involves "Drug Abuse Prevention & Control-Prohibited acts A" showed the biggest increase (150 percent) while the charge of "Fed Food, Drug & Cosmetics Act - Prohibited acts" showed the biggest decline (51.5 percent).

The study estimates that in 2015 the government obtained two healthcare fraud prosecutions for every one million people in the U.S. If the rate of prosecutions for 2016 remains the same throughout the year, there will be a decline to 1.5 health care fraud prosecutions per million people.