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Health Insurance: Vulnerable Payers Lose Billions to Fraud and Abuse

HRD-92-69 Published: May 07, 1992. Publicly Released: May 07, 1992.
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Pursuant to a congressional request, GAO examined the: (1) nature of fraud and abuse associated with the health care industry; and (2) problems insurers have in detecting and pursuing such fraud and abuse.


Matter for Congressional Consideration

Matter Status Comments
Congress should consider establishing a national commission to combat health insurance fraud and abuse with a membership balanced in terms of viewpoints represented. Such a commission could include public and private payers and personnel from federal and state investigative and prosecutorial agencies to develop strategies and evaluate legislative remedies for combatting health insurance fraud and abuse.
Closed – Not Implemented
Many of the issues GAO recommended for study under the auspices of a "National Commission" were examined by an HHS, OIG, DOJ action team. These same issues are being explored during the ongoing health reform debate. In fact, legislative remedies were proposed by both the "action team" and the President's and others' health reform bills. Consequently, there is no longer a need for a National Commission to study these issues and identify legislative remedies. The recommendation can be closed.

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Erroneous paymentsFraudHealth insurance cost controlInsurance companiesInvestigations by federal agenciesKickbacksLaw enforcementMedicaidMedical expense claimsMedicarePhysiciansProgram abusesHealth care fraud