Summary: Only a fraction of health care fraud and abuse is ever detected and prosecuted. Those cases, however, have involved substantial sums. Due to a lack of staff and money, effective investigation and pursuit of health care fraud has been impossible, allowing dishonest health care providers to stay in business. An essential health care goal must be to improve insurers' access to legal and punitive remedies to fraud and abuse. Yet more resources alone will not successfully overcome fraud and abuse. Structural issues like limitations on information sharing among insurers and incompatible data systems allow unscrupulous providers to move from one insurer to the next. GAO believes that Congress should convene a national health care fraud commission composed of private and public payers, providers, and law enforcement agencies. In GAO's view, such a commission would be best able to weigh possible trade-offs: greater information sharing among insurers versus concerns about privacy and antitrust issues, greater regulation of provider ownership arrangements versus concerns about restraining competition, and investment of resources in health care fraud versus the devotion of resources to other criminal investigations.
