Health Care Fraud, a new 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 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."

This 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.

In reviewing extensive data on health care fraud, the analysis points to evidence that fraud can emanate from the insurance industry itself. This finding is underscored by recent court decisions as well as by New York State's recent prosecution of multiple insurers for fraud in connection with provider claims payments as part of their administration of private insurance products and employee health benefit plans.

This report was funded with a Grant from the Robert Wood Johnson Foundation.

Resources

• Health Care Fraud
• Health Insurance Fraud: An Overview

Are you interested in health policy? Do you want to stay abreast of health policy reform legislation?

George Washington University's Hirsh Health Law and Policy Program at the School of Public Health and Health Services have created the National Health Reform Law and Policy Project. This project provides comparative analyses and summaries of the major pieces of health reform legislation in the 111th Congress.

The Project will track health policy reform legislation from legislation through and into implementation. Before preparing the analyses, GWUMC faculty and staff worked with experts in health care policy and management to determine which questions should be asked when considering health care policy and legislation. The Project uses these questions to frame their analyses.

The National Health Reform Law and Policy Project includes:

• A user's guide to navigating project contents
• A taxonomy that identifies the major themes guiding the comparative legislative analysis
• Comparative legislative tables showing provisions in each analyzed proposal and viewable independently or comparatively (side by side)
• Comprehensive summaries of each proposal and links to the actual legislation

"People in the bottom billion are the poorest in the world; they are often subsistence farmers, who essentially live on no money and are stuck in a poverty trap of disease, conflict, and no education. One of the most potent reinforcements of the poverty trap is the neglected tropical diseases. Almost everyone in the bottom billion has at least one of these diseases."

Hotez, P. J., Fenwick, A., Savioli, L., & Molyneux, D. H. (2009). Rescuing the bottom billion through control of neglected tropical diseases. Lancet, 373(9674), 1570-1575.

GWUMC's Peter Hotez is the first author on an article published in the May 2 issue of The Lancet. "Rescuing the bottom billion through control of neglected tropical diseases" outlines low-cost methods of controlling neglected tropical disease. The article describes:

• How neglected tropical diseases reinforce a cycle of poverty.
• Specific diseases and the geographic regions where they occur.
• Current availability of the drugs required to treat these diseases.

Image: Central Intelligence Agency (No Date). Political Map of the World. [Online image]. Retrieved May 7, 2009 from https://www.cia.gov/library/publications/the-world-factbook/reference_maps/political_world.html.