An Examination of Gender Differences in Health Care Fraud

Open Access
Cooper, Justin
Area of Honors:
Bachelor of Arts
Document Type:
Thesis Supervisors:
  • Darrell J Steffensmeier, Thesis Supervisor
  • Stacy Silver, Honors Advisor
  • Health Care Fraud
  • Fraud
  • Gender Differences
  • Gender
  • Health Care
Last year, The National Health Care Anti-Fraud Association estimated that 3% to 10% of the nation’s annual health care outlay is lost to fraud and abuse and that millions of Americans were affected (2017). With the prevalent nature of health care fraud in our social fabric, it is important for researchers to better understand and bring awareness to this serious problem. This honors thesis contributes to past research on financial fraud both in general and as regards to the extent and nature of female involvement in it. This thesis builds in particular on Steffensmeier and colleagues’ study of female involvement and gender differences in corporate financial fraud, titled: Twenty First Century Corporate Crime: Female Involvement and the Gender Gap in Enron-Era Corporate Frauds (2013). Four main questions are addressed in this honors thesis: (1) What effect does gender have on involvement in health care fraud and in different types of healthcare fraud? (2) What effect does gender have on the organization of the fraud (e.g. solo male, all-male, solo female, all-female, mixed-gender groups)? (3) What effect does gender have on the relationship that offenders have with others in mixed-gender groups? (4) What effect does gender have on the roles offenders play in mixed-gender groups? The primary source used to explore gender differences in health care fraud were collected from the United States Department of Justice (DOJ) Health Care Fraud Unit (HCF) press releases. Key findings were as follows: Overall, less women were involved in health care fraud than men. Findings also indicate that when it comes to the organization of fraud incidents, there are important differences by gender. A majority of males choose to work alone or in all-male groups, whereas females rarely commit fraud alone or with other females. Instead, an overwhelming proportion of females choose to work in mixed-gender groups, often playing a minor role. By extension, when females are offending within a mixed-gender group, a sizable portion commit heath care fraud with their family or kin. A gender disparity is also evident when looking at the type of fraud committed by gender. Of the five distinctive categories of health care fraud (e.g. pharmaceutical, reimbursement claims, kickbacks, medicare/medicaid, and money laundering), the majority of female defendants committed health care fraud in the form of kickbacks. Overall, the findings were similar and consistent with past research on gender and financial fraud.