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Criminal Resource Manual

976. Health Care Fraud—Generally

Health care fraud imposes an enormous cost to the health care system and to our nation's economy as a whole. While no one has an exact figure, the General Accounting Office estimates that health care fraud, waste and abuse may account for as much as 10 percent of all health care expenditures. Health care expenditures now exceed one trillion dollars each year, so that more than $100 billion may be lost in fraud, waste and abuse annually. Health care fraud also undermines both the cost and quality of health care provided to patients.

The Department's health care fraud efforts are centered in the United States Attorneys' Offices, the Criminal Division and the Civil Division. These efforts are coordinated by the Special Counsel to the Deputy Attorney General.

Yet successful health care fraud enforcement cannot be achieved by the Department of Justice acting alone. Americans currently receive health care from a plethora of private health insurance companies and several public programs. Each public program has its own rules for the provision of services, reimbursement for the costs of services, and the investigation of fraud. Perpetrators of health care fraud, however, rarely infiltrate just one health care system.

[cited in USAM 9-44.100]