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Video: The Shifting Landscape of Health Care Fraud and Regulatory Compliance

Regulators Increase Scrutiny As Health Care Costs Consume Higher Share of


NEW YORK, Aug. 19 /PRNewswire/ -- As health care costs continue to accelerate and consume an ever-higher percentage of GDP, federal and state regulators are ratcheting up efforts to find fraud. According to the Deloitte Forensic Center, criminal investigations, civil investigations, civil penalties and criminal convictions are all on the rise. The threat of treble damages, higher rewards for whistleblowers and more sophisticated "data mining" techniques give regulators more weapons in their fraud-fighting arsenal.

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Both for-profit and non-profit health care providers need to be alert to recent shifts in the regulatory environment that are making robust, top-to-bottom compliance with federal and state fraud laws and regulations more critical than ever.

News Facts

-- In fiscal 2007, federal enforcers got 560 criminal convictions and

collected $1.8 billion in civil judgments or settlements in health care

fraud cases.

-- Health care fraud "whistleblowers" can now receive up to 30 percent of

the amounts that regulators recover as a result of their tips -- a

powerful incentive.

-- Revised IRS Form 990, filed by large non-profits, may expose non-profit

health providers to higher scrutiny in their compensation and payments

to interested parties.

-- States have powerful incentives to increase their fraud enforcement and

recovery. New York State alone will have to increase its recoveries by

$470 million in one year so that it can keep federal funds used in


Trend Data

-- In fiscal year 2007, the federal government initiated 878

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