Healthcare Fraud Today, Healthcare Fraud Tomorrow, Healthcare Fraud Forever?

Hopefully not forever, but the point is that healthcare fraud enforcement has been a major priority of the federal government for some time, and there’s no end in sight.

The reasons for this are not hard to understand. We reportedly spend around $3 trillion on health care as a country, and for decades, that number has been growing in both absolute and relative terms and as a percentage of gross domestic product. Although the growth rate has leveled off since the recent economic downturn, the cost of health care is still closing in on 20% of GDP, and for government, our combined state and federal spending exceeds $1 trillion by a hundred billion dollars or two. Now that’s a lot of jack cheese. With the first baby boomers reaching the new benchmark retirement age of 67 last year, healthcare fraud enforcement will continue to be a high priority for the foreseeable future.

The statistics bear it out. This report from a research center at Syracuse University looks at the rising tide of prosecutions under just the basic federal healthcare fraud statute, 18 U.S.C. § 1347. (There are plenty of other laws to run afoul of.) It finds that fiscal year 2013 delivered the highest number of new cases since the statute was enacted in 1996. The count in FY 2013 was up 3% from FY 2012, nearly 8% from five years ago, and 10% from ten years ago. Most of these cases were brought either by the Department of Justice by way of the Federal Bureau of Investigation or by the Department of Health and Human Services, which administers our Medicare and Medicaid programs. On a per-capita basis, the federal judicial districts that saw the most filings were the Southern District of Illinois, which had the fastest growth rate in the last year, and the Southern District of Florida. See here for yourself.