Article Commentary: Penalties for health care fraud and abuse: January 2007-March 2008

Abstract

This commentary details the providers, penalties, and affected regions resulting from US health care fraud and abuse prosecutions from January 2007 to March 2008. Database review found that over $3 billion in fines as well as incarceration in some cases were ordered for 21 convicted providers, 68 percent of whom were physicians, and to 41 nonproviders, most of whom were vendors of durable medical goods (36%), individual citizens (18%) and health care corporations (17%). Fewer claims were found against pharmaceutical firms (7%) and medical equipment manufacturers (4%). Most verdicts were in the state of Florida. False claims accounted for most of the violations for both providers and nonproviders. These severe repercussions of malfeasance should promote careful consideration and construction of the terms of engagement between health care providers, corporations, and payers.

Get full access to this article

View all access options for this article.

References

1. Brainy Quotes. Nelson Mandela. Available at: http://www.brainyquote.com/quotes/authors/n/nelson_mandela.html. Accessed October 18, 2008

2. Shah

Smith

Ziv

. A warning to physicians: changing landscape of the corporate-provider relationship. Otolaryngol Head Neck Surg 2008;138:697–9

3. Shah

Smith

Devaiah

. Corporate-physician relationships: a need for education. Otolaryngol Head Neck Surg. In press

4. Office of Inspector General, Department of Health and Human Services. OIG Reports More Than $2 Million from Recoveries in Fighting Fraud, Waste, and Abuse for First-Half FY 2008 [news release]. June 12, 2008. Available at: http://www.oig.hhs.gov/publications/docs/press/2008/semiannual_press_spring2008.pdf. Accessed October 6, 2008

5. Office of Inspector General, Department of Health and Human Services.

Notes: OIG Compliance Program Guidance for Pharmaceutical Manufacturers.

Fed Regist 2003:86:23731–43. Available at: http://oig.hhs.gov/authorities/docs/03/050503FRCPGPharmac.pdf. Accessed October 14, 2008

6. Office of Inspector General, Department of Health and Human Services. Available at: http://www.oig.hhs.gov/fraud.asp. Accessed May 24, 2008

7. Kalb

. Health care fraud and abuse. JAMA 1999;282:1163–8

8. US Department of Justice. Nine Miami Defendants in Strike Force Cases Sentenced for $56.5 Million in Medicare Fraud Cases [press release]. January 23, 2008. Available at: http://www.usdoj.gov/opa/pr/2008/January/08_crm_049.html. Accessed November 23, 2008

9. US Department of Justice. Florida Pharmacy and Medicare Equipment Owner Sentenced to More Than 12 Years in Prison for Medicare Fraud [news release]. September 28, 2007. Available at: http://www.usdoj.gov/opa/pr/2007/September/07_crm_773.html. Accessed November 23, 2008

10.

10. Fick

. One bullet away Boston: Houghton Mifflin; 2005. p. 28