Corporate Compliance

FBI releases healthcare fraud information

Compliance Monitor, May 28, 2008

The FBI investigated 2,493 cases of healthcare fraud in fiscal year 2007, leading to 635 convictions, according to an agency report.
Those cases lead to:
  • $1.12 billion in restitutions
  • $4.4 million in recoveries
  • $34 million in fines
  • 308 seizures valued at $61.2 million
The FBI estimates fraudulent billing accounts for between 3% and 10% of all healthcare expenditures. CMS estimates $2.26 trillion was spent on healthcare in fiscal year 2007.
In the report, the FBI identified the most common types of healthcare fraud as:
  • Billing for services not rendered
  • Upcoding
  • Duplicate claims
  • Unbundling
  • Excessive services
  • Medically unnecessary services
  • Kickbacks


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