Health Insurance:

Legal and Resource Constraints Complicate Efforts to Curb Fraud and Abuse

T-HRD-93-3: Published: Feb 4, 1993. Publicly Released: Feb 4, 1993.

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GAO discussed health care fraud and abuse issues, focusing on: (1) the size and nature of health insurance fraud and abuse; and (2) resource and other problems associated with investigation and prosecution. GAO noted that: (1) health care insurance fraud and abuse contributed an estimated 10 percent to U.S. health care costs; (2) problems in combatting health insurance fraud and abuse include legal and administrative constraints which inhibit collaboration between independently operated health insurers, inadequate insurance and law enforcement resources, and the expense, time, and inability to recover financial losses as a result of pursuing criminal and civil action; (3) the lack of resources and an increasing and diverse workload have constrained the Department of Justice and the Department of Health and Human Services from providing sufficient investigative personnel; and (4) before health insurance fraud and abuse can be detected and prosecuted, greater resources will be needed and the lack of information-sharing between insurers and incompatible data systems needs to be resolved.

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