Health care fraud
Alternatives
- Enhance prosecution. Provide state attorneys general with an incentive to participate in the prosecution of DOD health care fraud by offering a portion of recovered funds from successfully prosecuted cases.
Advantages: Could increase the total number and speed with which DOD health care fraud cases are prosecuted.
Disadvantages: Does not address the problem of inadequate resources dedicated to detecting and investigating DOD health care fraud cases.
- Enhance detection and investigation. Provide a portion of recovered funds (5% to a maximum of $15 million annually) to the federal agencies charged with detection and investigation of DOD health care fraud to enhance their efforts.
Advantages: The bottleneck in government efforts to control military health care fraud occurs within the first two steps: detection and investigation. Returning a portion of recovered funds would serve as an incentive for superior performance, as well as allow for increased efforts in the fight against fraud. Current budget restrictions have precluded significant deterrent efforts; additional resources would be used to develop computer applications that detect and deter health care fraud more effectively.
Disadvantages: Funds previously recovered and returned to the DOD would be returned to detection/investigation agencies.
- Continue current efforts. No change in current detection, investigation, and prosecution efforts.
Advantages: Current efforts will uncover a certain level of health care fraud and will continue to recover a portion of fraudulent claims to the government.
Disadvantages: Fraud perpetrators will become increasingly sophisticated in their activities and will be able to stay one step ahead of overburdened government investigators.
- Develop additional data about the problem. Direct the Government Accountability Office to conduct a study on the feasibility of the alternatives.
Recommendation: Direct the Controller General of the U.S. to undertake a study and provide a report to Senator Smith on the feasibility of the above alternatives. Because of the magnitude of federal expenditures on health care, and the loss from health care fraud, it is essential to determine the best alternative based on empirical data.
It is helpful to compare alternatives by creating a scorecard. This is a two-dimensional grid with the evaluation criteria on the vertical axis and the different alternative policies on the horizontal axis with a notation for each alternative facilitating comparison of their strengths and weaknesses.
Another mechanism for helping people to understand an issue is a policy decision brief often referred to as a one page leave-behind. This provides a summary for the policymaker to read and to gain a grasp of the issue quickly. A standard format for a policy brief includes: summary of the issue, background information, analysis of alternatives, a recommendation for action, references, and personal contact information (Box 7-4).
Box 7-4
