Prosecutions of Health Care Fraud Law
Reach New High in FY 2013

Table 1. Criminal Prosecutions
of 18 USC 1347

Number Year-to-date 377
Percent Change from previous year 3
Percent Change from 5 years ago 7.7
Percent Change from 10 years ago 9.9

The latest available data from the Justice Department show that during FY 2013 the government reported 377 new prosecutions for cases with a lead charge of "18 USC 1347 - Health Care Fraud." According to the case-by-case information analyzed by the Transactional Records Access Clearinghouse (TRAC), this is the highest annual count since the statute was enacted, and is up 3 percent over the past fiscal year when the number of prosecutions totaled 366.

The comparisons of the number of defendants charged with this offense 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 350, the number of FY 2013 prosecutions of this type is up 7.7 percent. Prosecutions over the past year are still higher than they were ten years ago. Overall, the data show that prosecutions of this type are up 9.9 percent from the level of 343 reported in 2003.

The long term trend in prosecutions for 18 USC 1347 going back to FY 1997 is shown more clearly in Figure 1 (the statute was acted into law in August 1996). The vertical bars in Figure 1 represent the number of prosecutions recorded each fiscal year. Each presidential administration is distinguished by the color of the bars.

Bar chart of shortyear
Figure 1. Annual Criminal Prosecutions of 18 USC 1347

Pie chart of agengrp
Figure 2. Prosecutions by
Investigative Agency

Leading Investigative Agencies

The lead investigative agency for prosecutions through September 2013 was the Federal Bureau of Investigation (FBI) in the Department of Justice, accounting for 46.4 percent of prosecutions referred.

As shown in Figure 2, Health and Human Services (HHS) was the lead agency in 36.6 percent of the cases. Its role, however, is typically larger than this percentage suggests. Cases for which the FBI is the lead agency were often originated by HHS.

Referrals from state and local authorities were recorded as the lead investigative agency for 3.7 percent of the cases. The Postal Service was the lead agency for another 3.7 percent.

Top Ranked Judicial Districts

During FY 2013, there were 1.2 prosecutions under the lead charge of 18 USC 1347 for every million people in the United States, according to the Justice Department data. Understandably, there is great variation in the per capita number of prosecutions in each of the nation's ninety-four federal judicial districts. The districts registering the greatest counts for this statute, relative to population, are listed in Table 2.

Table 2. Top 10 Districts (per One Million People)
Judicial District Percapita Count Rank 1yr ago 5yrs ago 10yrs ago
Ill, S 10 13 1 32 21 15
Fla, S 9 61 2 1 1 4
S Car 7 34 3 61 34 54
Mich, E 7 46 4 5 11 30
D. C. 5 3 5 61 2 56
Ind, N 4 9 6 49 58 47
Ala, M 3 4 7 29 - -
Wyoming 3 2 8 - - -
Mo, E 3 9 9 6 31 -
N Dakota 3 2 10 61 58 56

  • The Southern District of Illinois (East St. Louis) — with 10.1 prosecutions per million people — was the most active through September 2013, with over eight times the national average of 1.2 prosecutions per million.

  • The Southern District of Florida (Miami) ranked second with 8.8 prosecutions per one million people. The Southern District of Florida (Miami) was ranked first a year ago as well as five years ago. The district's position ten years ago was fourth.

  • The District of South Carolina now ranks third with 7.2 prosecutions per million.

The federal judicial district which showed the greatest growth in the rate of prosecutions compared to one year ago — 1200 percent — was the Southern District of Illinois (East St. Louis). Compared to five years ago, the district with the largest growth — 709 percent — was South Carolina.

In the last year, the judicial District Court recording the largest drop in the rate of prosecutions — 30.8 percent — was the Eastern District of Missouri (St. Louis). 

Report Date: January 14, 2014
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Copyright 2014, TRAC Reports, Inc.