Federal Response to Health Care Fraud: An Exploratory Study of Issues and Challenges Facing Prosecutors

• In Event: Prosecutorial Decision Making, Discrimination and Misconduct

Abstract

Health care fraud harms beneficiaries through insufficient and inappropriate treatment while costing the United States tens, if not hundreds, of billions of dollars annually. The complex and continuously changing nature of health care fraud presents numerous challenges for prosecutors, with the Departments of Justice and Health and Human Services collaborating to identify, investigate, and prosecute health care fraud nationwide. Despite massive human and financial harms, “academia has paid almost no serious attention to this critical problem” (Sparrow, 2009). This lack of attention is particularly acute in the social sciences, where research has not kept pace with ongoing legal and technological changes in the health care system, with attendant changes in fraud likely. The National Institute of Justice, at the request of and in consultation with the Health Care Fraud Unit within the Fraud Section of the Department of Justice’s Criminal Division, is conducting an exploratory study to start to understand better the issues and challenges facing health care fraud prosecutors. This study endeavors to produce practical information to improve federal health care fraud prosecution and to stimulate greater social science interest in building knowledge around health care fraud. This paper reports on that study.

Authors

• Justin Pascal Bernstein, University of Maryland, College Park

• Phelan Wyrick, National Institute of Justice