
Contents
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A Social Problem That Comes in Many Shapes and Sizes A Social Problem That Comes in Many Shapes and Sizes
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The U.S. Health Care System: The Genesis of Fraud and Abuse The U.S. Health Care System: The Genesis of Fraud and Abuse
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The Flow of Services, Information, and Money: A Criminal’s Delight The Flow of Services, Information, and Money: A Criminal’s Delight
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Causes of Health Care Fraud Causes of Health Care Fraud
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Individual Influences Individual Influences
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Organizational Influences Organizational Influences
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Societal Influences Societal Influences
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The Salient Features of Health Care Fraud and Abuse The Salient Features of Health Care Fraud and Abuse
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The Dynamics of Health Care Fraud The Dynamics of Health Care Fraud
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Cite
Abstract
This book explores one serious social problem that is costing U.S. consumers and taxpayers billions of dollars a year: health care fraud and abuse. It examines whether the current definitions of “fraud” and “abuse” are too broad, and whether certain institutional arrangements such as fee-for-service systems or capitation plans are more (or less) conducive to fraud and abuse. It also assesses the effectiveness of the current laws and regulations for fighting health care fraud, the role of for-profit health care in reducing fraud, and what health care arrangements, financial incentives, and technologies can be used to curb fraud and abuse. This introduction provides an overview of the causes of health care fraud and abuse, along with its salient features and dynamics. In particular, it considers the similarities of health care fraud and abuse to other white-collar crimes and suggests that health care fraud is ever changing as perpetrators make adjustments.
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