Thursday, November 7, 2013

GAO Releases Fraud and Abuse Control Program Report

By Dianne De La Mare

The US Government Accountability Office (GAO) has recently released a report, Health Care Fraud and Abuse Control Program:  Indicators Provide Information on Program Accomplishments, but Assessing Program Effectiveness is Difficult, which examines how the US Department of Health and  Human Services (HHS), Office of Inspector General (OIG) and the Department of Justice (DOJ) use funds to achieve the goals of the Health Care Fraud and Abuse Control (HCFAC) program.  In FY 2012, OIG and DOJ obligated approximately $583.6 million to fund HCFAC program activities.  OIG and DOJ use several indicators to assess HCFAC activities, as well as to inform decision-makers about how to allocate resources and prioritize those activities. However, the indicators do not provide information about the effectiveness of the program, and little is known about whether and how well the HCFAC program reduces health care fraud. 

While positive results on the program’s return-on-investment can be seen as an indication of program success, the return-on investment does not indicate the extent to which the program is reducing fraud.  For example, the increasing returns from the fraud that is being investigated and prosecuted may indicate that HCFAC programming is effective in detecting or deterring potentially fraudulent schemes or indicate that there is simply an increase in potentially fraudulent activity.  Additionally, even with a baseline estimate of the total amount of probable fraud, there will likely be continuing challenges in understanding the effectiveness of the HCFAC program, such as isolating the program’s ability to reduce or prevent fraud and abuse.  Despite these inherent challenges, if a health care fraud baseline is established more broadly, it may become feasible to study how individual HCGAC activities, and possibly the program as a whole, affects changes in health care fraud.  To obtain a copy of the complete GAO report, click here.

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