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Health care fraud : types of providers involved in Medicare, Medicaid, and the Children's Health Insurance Program cases : report to congressional requesters.

Author: United States. Government Accountability Office.
Publisher: [Washington, D.C.] : U.S. Govt. Accountability Office, [2012]
Edition/Format:   eBook : Document : National government publication : English
Summary:
GAO has designated Medicare and Medicaid--which are administered by the Centers for Medicare & Medicaid Services (CMS), an agency of HHS--as high-risk programs partly because their size and complexity make them vulnerable to fraud. Several federal agencies conduct health care fraud investigations and related activities, including HHS-OIG and DOJ's Civil Division, and the 93 U.S. Attorney's Offices (USAO). In fiscal  Read more...
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Details

Genre/Form: Rules
Material Type: Document, Government publication, National government publication, Internet resource
Document Type: Internet Resource, Computer File
All Authors / Contributors: United States. Government Accountability Office.
OCLC Number: 823392278
Notes: Title from title caption (viewed on Dec. 31, 2012).
"September 2012."
QR code for online version of document included on title page.
"GAO-12-820."
Description: 1 online resource (iii, 51 pages) : illustrations
Details: Mode of access: World Wide Web.; System requirements: Adobe Acrobat reader.
Other Titles: Types of providers involved in Medicare, Medicaid, and the Children's Health Insurance Program cases
Fraud in Medicare, Medicaid, and CHIP

Abstract:

GAO has designated Medicare and Medicaid--which are administered by the Centers for Medicare & Medicaid Services (CMS), an agency of HHS--as high-risk programs partly because their size and complexity make them vulnerable to fraud. Several federal agencies conduct health care fraud investigations and related activities, including HHS-OIG and DOJ's Civil Division, and the 93 U.S. Attorney's Offices (USAO). In fiscal year 2011, the federal government devoted at least $608 million to conduct such activities. Additionally, state MFCUs investigate health care fraud in their state's Medicaid and CHIP programs. GAO was asked to provide information on the types of providers that are the subjects of fraud cases. This report identifies provider types who were the subjects of fraud cases in (1) Medicare, Medicaid, and CHIP that were handled by federal agencies, and changes in the types of providers in 2005 and 2010; and (2) Medicaid and CHIP fraud cases that were handled by MFCUs. To identify subjects of fraud cases handled by federal agencies, GAO combined data from three agency databases--HHS-OIG, USAOs, and DOJ's Civil Division--and removed duplicate subject data. GAO also reviewed public court records, such as indictments, to identify subjects' provider types because the USAOs and DOJ Civil Division data did not consistently include provider type. To describe providers involved in fraud cases handled by the MFCUs, GAO collected aggregate data from 10 state MFCUs, which represented the majority of fraud investigations, indictments, and convictions nationwide.

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