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Medicare Fraud in the United States: Can it Ever be Stopped?

Hill, Chelsea MS; Hunter, Alex MS; Johnson, Leslie DPT, MS, PT; Coustasse, Alberto DrPH, MD, MBA, MPH

doi: 10.1097/HCM.0000000000000019

The majority of the United States health care fraud has been focused on the major public program, Medicare. The yearly financial loss from Medicare fraud has been estimated at about $54 billion. The purpose of this research study was to explore the current state of Medicare fraud in the United States, identify current policies and laws that foster Medicare fraud, and determine the financial impact of Medicare fraud. The methodology for this study was a literature review. Research was conducted using a scholarly online database search and government Web sites. The number of individuals charged with criminal fraud increased from 797 cases in fiscal year 2008 to 1430 cases in fiscal year 2011—an increase of more than 75%. According to 2010 data, of the 7848 subjects investigated for criminal fraud, 25% were medical facilities, and 16% were medical equipment suppliers. In 2009 and 2010, the Health Care Fraud and Abuse Control Program recovered approximately $25.2 million of taxpayers’ money. Educating providers about the policies and laws designed to prevent fraud would help them to become partners. Many new programs and partnerships with government agencies have also been developed to combat Medicare fraud. Medicare fraud has been a persistent crime, and laws and policies alone have not been enough to control the problem. With investments in governmental partnerships and new systems, the United States can reduce Medicare fraud but probably will not stop it altogether.

Author Affiliations: Health Care Administration Program, College of Business, Marshall University Graduate College, South Charleston, West Virginia.

The authors have no conflict of interest.

Correspondence: Alberto Coustasse, DrPH, MD, MBA, MPH, Health Care Administration Program, College of Business, Marshall University Graduate College, 100 Angus E. Peyton Dr, South Charleston, WV 25303 (

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