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Member Research and Reports

Member Research and Reports

Johns Hopkins: Medicare Fraud and Abuse Linked to Patient Deaths and Hospitalizations

Patients treated by health care professionals later excluded from the Medicare program for committing fraud and abuse were between 14 to 17 percent more likely to die than similar patients treated by non-excluded physicians, nurses, and other professionals, according to a new study from researchers at Johns Hopkins Bloomberg School of Public Health.

The study estimates that fraud and abuse contributed to 6,700 premature deaths in 2013 alone.

The findings were published online on October 28 in JAMA Internal Medicine.

The study also found that patients treated by providers later banned from Medicare for fraud and abuse were 11 to 30 percent more likely to experience an emergency hospitalization in the year of exposure. The study found that providers later banned for fraud and abuse treated patients who were more likely to be low-income, non-white, and under-65 and disabled.

More than 47,000 health care professionals have been banned from Medicare and Medicaid, federal programs that provide health insurance to elderly, disabled, and low-income beneficiaries, because of fraud and abuse. Medical fraud and abuse can involve patient neglect, illegally providing prescription medications, unnecessary medical procedures, deceitful billing practices, practicing without a license and/or using untrained personnel for direct patient care. Fraudulent medical practice is estimated to cost the U.S. federal government between $30 to $140 billion dollars annually.

Dr. Lauren Hersch Nicholas, assistant professor in the Bloomberg School’s department of health policy and management, is the paper’s lead author.

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