In October 2012, the General Accountability Office (GAO ) reported to Congress on its study of the most common sources of fraudulent activities (both criminal and civil) among Medicare program participants. According to the GAO, medical facilities such as medical centers, clinics, and practices, and durable medical equipment suppliers were the most frequent subjects of criminal fraud cases in 2010. More than a quarter of the criminal prosecutions involved health centers; durable medical suppliers made up another 16%. These groups were the subjects in 20% and 18% of the civil actions, respectively. A very small percentage of fraud cases were brought against individual Medicare recipients.
Common health care fraud schemes include providers or suppliers (1) billing for services or supplies not provided or not medically necessary, (2) purposely billing for a higher level of service than that provided, (3) misreporting data to increase payments, (4) paying kickbacks to providers for referring beneficiaries for specific services or to certain entities, or (5) stealing providers' or beneficiaries' identities.
