According to a recent clearinghouse report, federal criminal prosecutions of health care fraud are up—way up—this year. According to an analysis that Transactional Records Access Clearinghouse (TRAC) conducted on statistics released by the U.S. Department of Justice (DOJ), in 2011 federal prosecutors initiated prosecution of 903 new health care fraud cases as of August. This means that before the end of the summer of 2011, DOJ had initiated more health fraud cases than it did in all of 2010.
In Puerto Rico alone, 420 defendants have been charged this year. Within the fifty states, the Southern District of Florida (Miami) led the nation in activity accounting for one out of every nine health care fraud prosecutions.
As noted by a recent analysis of the report by DLA Piper, if DOJ continues at this rate, it is on pace to reach 1,355 health care fraud cases by the end of 2011: approximately 85% more than in 2010.
Compared to five years ago when there were 528, the estimate of FY 2011 prosecutions of this type is up 157 percent. Prosecutions over the past year are much higher than they were ten years ago. Overall, the data show that prosecutions of this type are up 115 percent from the level of 631 reported in 2001 and up 822 percent from the level of 147 reported in 1991.
The lead investigative agency for health care fraud prosecutions through May 2011 was DOJ, Federal Bureau of Investigation (FBI), accounting for three out of four (75.7 percent) of prosecutions referred. Most of the remainder of the health care fraud prosecutions were as a result of investigations by Health and Human Services (HHS), which accounted for 18.2 percent.
The top lead charges recorded in the prosecutions of health care fraud matters filed in U.S. District Court during the first eight months of FY 2011 were:
- Health Care Fraud” (Title 18 U.S.C Section 1347) was the most frequent recorded lead charge. Title 18 U.S.C Section 1347 was ranked 1st a year ago, while it was the 1st most frequently invoked five years ago. It was ranked 1st ten years ago.
- Ranked 2nd in frequency was the lead charge “Mail Fraud – Attempt and Conspiracy” under Title 18 U.S.C Section 1349. Title 18 U.S.C Section 1349 was ranked 3rd a year ago, while it was the 6th most frequently invoked five years ago.
- Ranked 3rd was “Mail Fraud – Frauds and swindles” under Title 18 U.S.C Section 1341. Title 18 U.S.C Section 1341 was ranked 2nd a year ago, while it was the 5th most frequently invoked five years ago. It was ranked 2nd ten years ago and 1st twenty years ago.
Among these top ten lead charges, the one showing the greatest projected increase in prosecutions—up 2000 percent—compared to one year ago, was Title 18 U.S.C Section 1344 that involves “Bank Fraud “. This was the same statute that had the largest projected increase—1894%—when compared with five years ago.
Again among the top ten lead charges, the one showing the sharpest projected decline in prosecutions compared to one year ago—down 56.5 percent—was “False claims relating to health care matters ” (Title 18 U.S.C Section 1035 ). This was the same statute that had the largest projected decrease—67.4%—when compared with five years ago.
The breakdown for health care fraud prosecutions across the United States was:
- The Southern District of Florida (Miami)—with 22.94 prosecutions as compared with 4.4 prosecutions per one million people in the United States—was the most active through May 2011. The Southern District of Florida (Miami) was ranked 1st a year ago, while it was ranked 2nd five years ago. The district’s position ten years ago was 7th and 5th twenty years ago.
- The Southern District of Alabama (Mobile) ranked 2nd. The Southern District of Alabama (Mobile) was ranked 4th a year ago. The district’s position ten years ago was 23rd.
- The Southern District of Texas (Houston) now ranks 3rd.
- Relative to their population, the Southern District of New York (Manhattan) and the Eastern District of New York (Brooklyn) were, respectively, fourth and fifth in the nation in the number of criminal prosecutions these districts filed for health care fraud so far this year.
Also making the top ten federal judicial districts for health care fraud prosecutions were:
- Eastern District of Michigan
- Middle District of Georgia
- Eastern District of Missouri
- Western District of Oklahoma
- Eastern District of Virginia
The federal judicial district which showed the greatest projected growth in the rate of health care fraud prosecutions compared to one year ago—957 percent—was Western District of Oklahoma (Oklahoma City)
Discussion
This recent trend of health care fraud prosecutions continued early this month when DOJ announced on September 7th, a massive nationwide health care takedown in which DOJ charged 91 defendants—including physicians, nurses, and other health care professionals—for alleged participation in Medicare fraud schemes involving approximately $295 million in false billing. The charges stem from a greatly expanded Medicare Fraud Strike Force, which now operates in most major metropolitan areas.
It’s about time we started really cracking down on this. Maybe if we continue or even crack down harder we can start seeing healthcare price coming down which would do nothing but help us all.