Health Care Fraud Prosecutions for 2011
Number Year-to-date 903 Percent Change from previous year 85.4 Percent Change from 5 years ago 157 Percent Change from 10 years ago 115 Percent Change from 20 years ago 822
Table 1: Criminal Health Care Fraud ProsecutionsThe latest available data from the Justice Department show that during the first eight months of FY 2011 the government reported 903 new health care fraud prosecutions. Already the activity this year exceeds the level for all of FY 2010.
Numbers were pushed higher by a series of investigations by the Federal Bureau of Investigations which led to prosecutions for health care fraud. In Puerto Rico alone, 420 defendants have been charged this year. Within the fifty states, the Southern District of Florida (Miami) led the nation in activity accounting for one out of every nine health care fraud prosecutions.
Across the nation if this activity continues at the same pace, the annual total of prosecutions will be 1,355 for this fiscal year. According to the case-by-case information analyzed by the Transactional Records Access Clearinghouse (TRAC), this estimate is up 85.4% over the past fiscal year when the number of prosecutions totaled 731.
The comparisons of the number of defendants charged with health care fraud offenses are based on case-by-case information obtained by TRAC under the Freedom of Information Act from the Executive Office for United States Attorneys (see Table 1).
Compared to five years ago when there were 528, the estimate of FY 2011 prosecutions of this type is up 157 percent. Prosecutions over the past year are much higher than they were ten years ago. Overall, the data show that prosecutions of this type are up 115 percent from the level of 631 reported in 2001 and up 822 percent from the level of 147 reported in 1991.
The long term trend in health care fraud prosecutions for these matters going back to FY 1991 is shown more clearly in Figure 1. The vertical bars in Figure 1 represent the number of health care fraud prosecutions of this type recorded each fiscal year. Projected figures for the current fiscal year are shown. Each presidential administration is distinguished by the color of the bars.
Leading Investigative Agencies
The lead investigative agency for health care fraud prosecutions through May 2011 was "Justice - Federal Bureau of Investigation" accounting for three out of four (75.7 percent) of prosecutions referred.
Most of the remainder of the health care fraud prosecutions were as a result of investigations by Health and Human Services. It account for 18.2 percent.
Top Ranked Lead Charges
Table 2 shows the top lead charges recorded in the prosecutions of health care fraud matters filed in U.S. District Court during the first eight months of FY 2011.
Note: There were an additional 34 other lead charges which were not individually ranked because of their low volume. Use TRACFED criminal analyzer tool for complete listing for any year.
Lead Charge Count Rank 1 yr ago 5 yrs ago 10 yrs ago 20 yrs ago 18 USC 1347 - Health Care Fraud 251 1 1 1 1 - More 18 USC 1349 - Mail Fraud - Attempt and Conspiracy 226 2 3 6 - - More 18 USC 1341 - Mail Fraud - Frauds and swindles 208 3 2 5 2 1 More 18 USC 1033 - Insurance Fraud 68 4 38 - 25 - More 18 USC 1344 - Bank Fraud 28 5 22 38 20 9 More 42 USC 1320a-7 - Exclusion of certain individuals and entities from participation in Medicare and State health care programs 20 6 8 38 - - More 18 USC 371 - Conspiracy to commit offense or to defraud US 15 7 6 2 3 3 More 21 USC 331 - Fed Food, Drug & Cosmetics Act - Prohibited acts 10 8 5 3 6 - More 18 USC 1035 - False claims relating to health care matters 9 9 4 4 7 - More 18 USC 1519 - Destruct, alter, falsify records in fed. investigations and bankruptcy 8 10 18 - - - More 42 USC 1320 - Social Security - Approval of certain projects 8 10 38 8 4 3 More
Table 2: Top charges filed
"Health Care Fraud" (Title 18 U.S.C Section 1347) was the most frequent recorded lead charge. Title 18 U.S.C Section 1347 was ranked 1st a year ago, while it was the 1st most frequently invoked five years ago. It was ranked 1st ten years ago.
Ranked 2nd in frequency was the lead charge "Mail Fraud - Attempt and Conspiracy" under Title 18 U.S.C Section 1349. Title 18 U.S.C Section 1349 was ranked 3rd a year ago, while it was the 6th most frequently invoked five years ago.
Ranked 3rd was "Mail Fraud - Frauds and swindles" under Title 18 U.S.C Section 1341. Title 18 U.S.C Section 1341 was ranked 2nd a year ago, while it was the 5th most frequently invoked five years ago. It was ranked 2nd ten years ago and 1st twenty years ago.
Among these top ten lead charges, the one showing the greatest projected increase in prosecutions—up 2000 percent—compared to one year ago was Title 18 U.S.C Section 1344 that involves "Bank Fraud ". This was the same statute that had the largest projected increase—1894%—when compared with five years ago.
Again among the top ten lead charges, the one showing the sharpest projected decline in prosecutions compared to one year ago—down 56.5 percent—was "False claims relating to health care matters " (Title 18 U.S.C Section 1035 ). This was the same statute that had the largest projected decrease—67.4%—when compared with five years ago.
Top Ranked Judicial Districts
During FY 2010 the Justice Department said the government obtained 2.4 health care fraud prosecutions for every one million people in the United States. If pace during the first eight months of FY 2011 continues at the same rate, health care fraud prosecutions for one million people in the United States this year will be 4.4 . Understandably, there is great variation in the per capita number of health care fraud prosecutions in each of the nation's ninety-four federal judicial districts
Judicial District Percapita Count Rank 1yr ago 5yrs ago 10yrs ago 20yrs ago Fla, S 23 102 1 1 2 7 5 More Ala, S 22 12 2 4 - 23 - More Texas, S 11 61 3 20 45 52 14 More N. Y., S 9 31 4 23 12 4 - More N. Y., E 7 38 5 16 51 66 - More Mich, E 7 30 6 7 8 28 11 More Ga, M 7 9 7 6 62 65 15 More Mo, E 6 11 8 22 7 25 10 More Okla, W 5 7 9 58 39 73 - More Virg, E 4 15 10 57 17 10 - More
Table 3: Top 10 districts (per one million people)
The Southern District of Florida (Miami)—with 22.94 prosecutions as compared with 4.4 prosecutions per one million people in the United States—was the most active through May 2011. The Southern District of Florida (Miami) was ranked 1st a year ago, while it was ranked 2nd five years ago. The district's position ten years ago was 7th and 5th twenty years ago.
The Southern District of Alabama (Mobile) ranked 2nd. The Southern District of Alabama (Mobile) was ranked 4th a year ago. The district's position ten years ago was 23rd.
The Southern District of Texas (Houston) now ranks 3rd.
Relative to their population, the Southern District of New York (Manhattan) and the Eastern District of New York (Brooklyn) were, respectively, fourth and fifth in the nation in the number of criminal prosecutions these districts filed for health care fraud so far this year.
The federal judicial district which showed the greatest projected growth in the rate of health care fraud prosecutions compared to one year ago—957 percent—was Western District of Oklahoma (Oklahoma City). Compared to five years ago, the district with the largest projected growth—1210 percent—was Middle District of Georgia (Macon) .
Report date: August 17, 2011
