"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.

“Health Care Fraud” is available at http://www.gwumc.edu/sphhs/departments/healthpolicy/dhp_publications/pub_uploads/dhpPublication_924894E4-5056-9D20-3DA16EE2DF2E2336.pdf

 

A separate brief, “Health Insurance Fraud: An Overview” is available

at

 

Contacts

Maria Ibañez, NASHP

202.507.7584

 

Anne Banner, GW

202.994.2261

 

The George Washington University Medical Center is an internationally recognized interdisciplinary academic health center that has consistently provided high-quality medical care in the Washington, DC metropolitan area, since 1824. The Medical Center comprises the School of Medicine and Health Sciences, the 11th oldest medical school in the country; the School of Public Health and Health Services, the only such school in the nation’s capital; GW Hospital, jointly owned and operated by a partnership between The George Washington University and a subsidiary of Universal Health Services, Inc.; and the GW Medical Faculty Associates, an independent faculty practice plan. For more information on GWUMC, visit www.gwumc.edu ( http://www.gwumc.edu/ ).

 

The National Academy for State Health Policy (NASHP) is an independent academy of state health policy makers working together to identify emerging issues, develop policy solutions, and improve state health policy and practice. As a non-profit, non-partisan organization dedicated to helping states achieve excellence in health policy and practice, NASHP provides a forum on critical health issues across branches and agencies of state government. For more information about NASHP, please visit www.nashp.org ( http://www.nashp.org/ )