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Copyright (c) 2001 American Criminal Law Review
American Criminal Law Review

ARTICLE: Health Care Fraud

Summer, 2001

38 Am. Crim. L. Rev. 913


Nicole A. Berryman, Darcy E. Feuerzeig and Elizabeth R. Jungman



The Health Care Financing Administration ("HCFA") estimates that by the year 2008, health care spending will reach $ 2.2 trillion and will account for 16.2% of the Gross Domestic Product. 1 Thus, it is no surprise that white collar criminals view health care fraud as a lucrative endeavor. 2 Indeed, the General Accounting Office ("GAO") estimates that such fraud accounts for up to 10% of total health care expenditures. 3 As health care fraud costs taxpayers nearly $ 100 billion a year, 4 federal and state agencies have made health care fraud prosecution a primary focus. 5 During her term, Attorney General Janet Reno made prosecuting health care fraud a top priority at the Department of Justice ("DOJ"), second only to violent crime. 6

The government concentrates its efforts to detect and prosecute health care fraud in the federal health care insurance programs, Medicare and Medicaid. 7 Statutes enacted to deal with fraud in these specific programs 8 have become necessities because "as the government's second largest social program, Medicare continues to be an attractive target for fraud and abuse." 9

Persons and organizations certified by Department of Health and Human Services ("HHS") to receive payment under the Social Security Act might be subject to Medicare and Medicaid fraud investigations. 10 Persons and organizations include hospitals, nursing and rehabilitation centers, Health Maintenance Organizations ("HMOs"), intermediate carriers such as private insurance companies, private and public clinics, medical laboratories, durable medical equipment ("DME") providers, physicians, ...
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