Dishonest Hospitals and Medical Centers Top in Healthcare Fraud Investigations

According to a recent Government Accountability Office (GAO) report, dishonest hospitals and medical facilities are the leading concerns of health care fraud investigations. In civil cases, hospitals were the most frequently investigated subjects, making up 20 percent of the 2,399 subjects, slightly more than medical facilities—defined as medical centers, clinics and practices—at 18 percent. For all health care civil fraud cases, about 61 percent of the subjects investigated were organizations and not individuals affiliated with those entities. According to the report, physicians represented only 12 percent of the civil health care fraud suspects.

Clearly, civil health care fraud investigations tend to focus on large health care providers, as opposed to individual providers. This investigatory focus likely reflects the recent success and proliferation of False Claims Act qui tam actions, which tend to spotlight systematic, business-plan healthcare fraud schemes.

More information for whistleblowers is located at the Nolan Auerbach website.