
Contents
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Bilking Medicare out of $47 Billion Bilking Medicare out of $47 Billion
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Three Approaches to Reducing Criminal and Corrupt Acts Three Approaches to Reducing Criminal and Corrupt Acts
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The Health Care Provider The Health Care Provider
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Internal Corporate Compliance Programs Internal Corporate Compliance Programs
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The Deprofessionalization of the Health Care Disciplines The Deprofessionalization of the Health Care Disciplines
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The Health Care Consumer The Health Care Consumer
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Private Health Insurers Private Health Insurers
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The Biggest Players of All: Federal and State Governments The Biggest Players of All: Federal and State Governments
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No New Legislation, Just Fewer Big-Dollar Settlements and More Prison Time No New Legislation, Just Fewer Big-Dollar Settlements and More Prison Time
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The Critical Role of the Centers for Medicare and Medicaid Services The Critical Role of the Centers for Medicare and Medicaid Services
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Additional Statistical Antifraud Measures Additional Statistical Antifraud Measures
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Investigating and Prosecuting Health Care Fraud and Abuse Cases Investigating and Prosecuting Health Care Fraud and Abuse Cases
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A Note on the Federal Sentencing Guidelines A Note on the Federal Sentencing Guidelines
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Sentencing Individual Defendants Sentencing Individual Defendants
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Punishing the Organization Punishing the Organization
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6 Fighting Health Care Fraud and Abuse
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Published:March 2011
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Abstract
This chapter discusses ways of reducing health care fraud and abuse. It first proposes three approaches to reducing crime and corruption: making it more difficult for the individual perpetrator to commit a criminal or corrupt act and goes on to consider strategies for dealing with health care providers involved in fraudulent activities, along with antifraud measures taken by private health insurers. It then stresses the importance of educating health care consumers to protect them against health care scam artists and dishonest providers. It also examines the role of federal and state governments in the fight against health care fraud, with particular emphasis on the Centers for Medicare and Medicaid Services, and explains how health care fraud and abuse cases are investigated and prosecuted. The chapter concludes with a brief overview of the Federal Sentencing Guidelines for various crimes, including white-collar crimes such as health care fraud.
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