Medical facilities, DME suppliers represent 40% of fraud cases

Friday, October 12, 2012

WASHINGTON – Medical facilities and durable medical equipment suppliers were the most frequent subjects of criminal cases for Medicare and Medicaid fraud, according to an Oct. 9 report from the Government Accountability Office (GAO).

In 2010, about 40% of the subjects of criminal cases were medical facilities—including medical centers, clinics or practices—and DME suppliers. In 2005, they represented about 41% of the subjects of criminal cases, according to the GAO.

To conduct the report, titled “Types of Providers Involved in Medicare, Medicaid and the Children’s Health Insurance Program Cases,” the GAO examined data from Department of Health and Human Services (HHS), the Office of Inspector General (OIG) and the Department of Justice (DOJ).

The GAO found that, in all, 10,187 subjects were investigated for healthcare fraud in 2010. Of those, 7,848 were subjects of criminal cases and 2,339 were subjects of civil cases, including cases that resulted in judgments or settlements.

Hospitals and medical facilities were the most frequent subjects of civil fraud cases, according to the GAO.

To read the full report:



I followed the link.  The GAO seems to be saying that 75% of the civil cases, and 85% of the criminal cases, had no judgment or settlement.  Looking deeper, it seems some settlements might be among the 85% (part of the "Other"?), but still, over half seem to have amounted to nothing?  Am I understanding this correctly?