GAO: Hospitals biggest target of civil health fraud investigations

Hospitals and medical centers are frequent suspects of civil and criminal healthcare fraud, the Government Accountability Office said in a new report crunching the 2010 numbers.

In civil cases, hospitals were the most frequently investigated subjects, making up 20 percent of the 2,339 subjects, slightly more than medical facilities--defined as medical centers, clinics and practices--at 18 percent. 

For all healthcare civil fraud cases, about 61 percent of the subjects investigated were organizations and not individuals affiliated with those entities. Physicians represented only 12 percent of the civil healthcare fraud suspects, according to the GAO report.

However, in criminal cases, non-hospital medical facilities were the largest portion of investigated entitites, at 25 percent of the 7,848 cases. Hospitals accounted for fewer than 5 percent of criminal healthcare fraud investigations.

Earlier this summer, the GAO and the Office of Inspector General blasted the Centers for Medicare & Medicaid Services for weak anti-fraud programs. The agencies said poor oversight data leaves Medicare and Medicaid vulnerable to fraudulent activity.

To learn more:
- here's the GAO report (.pdf) and summary