1. DOJ Pharmaceutical Prosecutions
Michael Loucks
First Assistant U.S. Attorney
District of Massachusetts

2. MEDICARE/MEDICAID SPENDING TRENDS (In Billions)
1,140.2

3. How Much Fraud is there?
1992 GAO report estimated fraud and abuse was as high as 10% of the dollars spent on health care.
If accurate, in a year in which society spends $1,000 billion on health care, $100 billion is stolen through fraud.

4. Resolutions > $10,000,000 (110) Years Total Recoveries
Criminal Fines %
856,600,000
125,300,000
14.6
3,602,040,776
349,000,000
9.7
2001-Aug 2006
9,362,622,955
1,254,091,556
13.4
Totals
13,821,263,731
1,477,792,815
10.6

5. Drug Industry Cases Years Total Recoveries Pharma Cases % 1991-1995
856,600,000
171,000,000
19.9
3,602,040,776
274,440,776
7.6
2001-Present
9,362,622,955
5,388,666,004
57.6
Totals
13,821,263,731
5,834,106,780
42.2

6. The 110 Resolutions: sectors
Ambulance: 2
Carriers: 7
Dialysis: 5
DME: 2
Home Health: 5
Hospital: 29
Laboratory: 10
Medical Device: 10
Pharmaceutical: 28
Program Eligibility: 3
Rehabilitative Medicine Services: 1

7. The 110 Resolutions: by size
$500,000,000+: 7
$250,000,000-$500,000,000: 12
$100,000,000-$250,000,000: 14
$50,000,000-$99,999,999: 17
$20,000,000-$49,999,999: 29
$10,000,000-$19,999,999: 31