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Search - License to Steal: How Fraud Bleeds America's Health Care System

License to Steal How Fraud Bleeds America's Health Care System
Author: Malcolm Sparrow

An explanation of how thieves exploit the U.S. health system and steal more than $100 billion each year.Fraud and abuse bleeds more than 100 billion dollars each year out of the U.S. health system. This detailed examination shows the problem is worse than almost anyone knows, mostly invisible, and still far from controlled. Sparrow reveals that ... more »current control systems fail by presenting fraud perpetrators with a safe, easy-to-hit target: fully automated check-printing systems, which only require thieves to bill "correctly," regardless of whether or not any medical service is provided. This target attracts an extraordinary range of criminal entrepreneurs, from low-life hoods who sign on as Medicare or Medicaid providers equipped with nothing more than beepers and mailboxes, to drug trafficking organizations, organized crime syndicates, even major hospital chains. Sparrow's research examines the much-misunderstood effects of managed care on the problem, the government's recent attempts to grapple with fraud, and the campaign by various provider associations to undermine those efforts.TOC: PrefaceAcknowledgmentsIntroductionFictitious CompaniesThe State of the ArtControl FailuresTwo Distinct Sciences: Fraud Detection, and Utilization Review, How Goes the War?Counterattack, New Frontiers for ControlFalse ClaimsManaged CareThe Nature of the Fraud-Control ChallengeThe Pathology of Fraud ControlThe Importance of MeasurementAssessment of Existing Fraud-Control SystemsThe Antithesis of Modern Claims ProcessingPrescription for ProgressA Model Fraud-Control StrategyDetection SystemsConclusionAcronyms and AbbreviationsNotesIndexBIO: Malcolm K. Sparrow teaches Regulatory and Enforcement Strategy, and Analytic Methods, at Harvard's John F. Kennedy School of Government. Formerly a Detective Chief Inspector with the British police service, he now specializes in issues of enforcement strategy, regulatory compliance, and risk control--he is the acknowledged national expert on the subject of Health Care Fraud. He is author of The Risk Business: Defining the Regulatory Craft (2000), License to Steal: Why Fraud Plagues America's Health Care System (1996), Imposing Duties: Government's Changing Approach to Compliance (1994); and co-author of Beyond 911: A New Era for Policing (1990) and Ethics in Government: The Moral Challenge for Public Leadership (1990).

ISBN-13: 9780813368108
ISBN-10: 0813368103
Publication Date: 7/1/2000
Pages: 283
Rating:

Currently 2.5/5 Stars.

2.5 stars, based on 1 rating

Publisher: Westview Press
Book Type: Hardcover
Members Wishing: 0
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