S. Health Care Fraud

Health care fraud is a serious problem in the United States. Even before the COVID-19 pandemic, national health care spending was estimated to exceed $4 trillion in 2020, representing 18% of GDP. By one estimate, up to 10% of health care spending may be due to fraud and abuse, resulting in significant financial losses for consumers, government, and private plans and perhaps even more problematic, posing serious harm to patients.



This course will review health care fraud and abuse schemes; federal and state criminal, civil and administrative enforcement, and prevention tools including whistleblower qui tam suits, compliance, technology, and data analysis. We will examine how fraud affects certain health care providers such as nursing homes, mental health and substance abuse programs, and hospitals as well as the particular vulnerabilities of responses to COVID-19 such as telemedicine, testing, and vaccines. Where applicable, we will explore the effect of changing federal administrations on enforcement practices. Over the semester, students may participate in simulations applying the course material to different practical scenarios such as interviewing a whistleblower, counseling physicians affiliated with academic medical centers or practicing telemedicine, and advising a public health agency responding to COVID-19.