Federal Health Care Fraud Statute Sentencing in Georgia and Florida, 2011-2012.

摘要

The financial costs of U.S. federal health care fraud continue to increase, and as health care payments due to fraudulent claims increase, the portion of The Medicare Trust Fund available to pay for legitimate health care expenses decreases. Prosecution is one of several fraud management life cycle components that contributes to and can alter the course of increasing health care fraud; however, despite this recognition, there is a gap in the literature regarding the consistency of prosecution for federal health care fraud across different judicial districts. The purpose of this qualitative, exploratory multiple case study was to explore the federal sentencing consistency across 6 judicial districts in Georgia and Florida during 2011 and 2012 using Wilhelm's Fraud Management Life Cycle as the theoretical lens. Data consisted of publicly available records of 147 terminated federal cases in Georgia or Florida from 2011 and 2012 involving prosecutions for health care-related fraud. These data were inductively coded and analyzed using a content analysis procedure. Findings indicated physical and monetary sentencing inconsistencies when comparing the sentence delivered for similar federal health care fraud cases across judicial jurisdictions. This study promotes positive social change by demonstrating inconsistencies in federal health care sentencing and understanding that consistent sentencing will lead to greater deterrence. Prosecutors and judges will benefit from this knowledge in making more consistent sentencing decisions related to federal fraudulent health care payments.