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Fighting Health Care Fraud and Abuse

Terry L. Leap

in Phantom Billing, Fake Prescriptions, and the High Cost of Medicine: Health Care Fraud and What to Do about It

Published in print:
2011
Published Online:
August 2016
ISBN:
9780801449796
eISBN:
9780801460807
Item type:
chapter
Publisher:
Cornell University Press
DOI:
10.7591/cornell/9780801449796.003.0006
Subject:
Sociology, Health, Illness, and Medicine

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 ... More


The Big Picture

Terry L. Leap

in Phantom Billing, Fake Prescriptions, and the High Cost of Medicine: Health Care Fraud and What to Do about It

Published in print:
2011
Published Online:
August 2016
ISBN:
9780801449796
eISBN:
9780801460807
Item type:
chapter
Publisher:
Cornell University Press
DOI:
10.7591/cornell/9780801449796.003.0008
Subject:
Sociology, Health, Illness, and Medicine

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 ... More


Fraud in Fee-for-Service and Managed Care: Different Sides of the Same Coin

Terry L. Leap

in Phantom Billing, Fake Prescriptions, and the High Cost of Medicine: Health Care Fraud and What to Do about It

Published in print:
2011
Published Online:
August 2016
ISBN:
9780801449796
eISBN:
9780801460807
Item type:
chapter
Publisher:
Cornell University Press
DOI:
10.7591/cornell/9780801449796.003.0003
Subject:
Sociology, Health, Illness, and Medicine

This chapter examines fraud in fee-for-service systems and managed care plans. A common health care fraud that is linked directly to fee-for-service is the submission of fraudulent claims to the ... More


Health Care Fraud and Its Facilitating Crimes

Terry L. Leap

in Phantom Billing, Fake Prescriptions, and the High Cost of Medicine: Health Care Fraud and What to Do about It

Published in print:
2011
Published Online:
August 2016
ISBN:
9780801449796
eISBN:
9780801460807
Item type:
chapter
Publisher:
Cornell University Press
DOI:
10.7591/cornell/9780801449796.003.0001
Subject:
Sociology, Health, Illness, and Medicine

This chapter examines health care fraud and abuse as well as the crimes that facilitate it. It first considers the definition of fraud, how fraud differs from abuses such as price gouging or mistakes ... More


Conclusion

Terry L. Leap

in Phantom Billing, Fake Prescriptions, and the High Cost of Medicine: Health Care Fraud and What to Do about It

Published in print:
2011
Published Online:
August 2016
ISBN:
9780801449796
eISBN:
9780801460807
Item type:
chapter
Publisher:
Cornell University Press
DOI:
10.7591/cornell/9780801449796.003.0007
Subject:
Sociology, Health, Illness, and Medicine

This book concludes by revisiting several broad questions that are integral to health care fraud and abuse: whether the current definitions of “fraud” and “abuse” are too broad; whether certain ... More


Phantom Billing, Fake Prescriptions, and the High Cost of Medicine: Health Care Fraud and What to Do about It

Terry L. Leap

Published in print:
2011
Published Online:
August 2016
ISBN:
9780801449796
eISBN:
9780801460807
Item type:
book
Publisher:
Cornell University Press
DOI:
10.7591/cornell/9780801449796.001.0001
Subject:
Sociology, Health, Illness, and Medicine

U.S. health care is a $2.5 trillion system that accounts for more than 17 percent of the nation's GDP. It is also highly susceptible to fraud. Estimates vary, but some observers believe that as much ... More


Fraud at Major Hospitals: Profits at Any Cost, Part One

Terry L. Leap

in Phantom Billing, Fake Prescriptions, and the High Cost of Medicine: Health Care Fraud and What to Do about It

Published in print:
2011
Published Online:
August 2016
ISBN:
9780801449796
eISBN:
9780801460807
Item type:
chapter
Publisher:
Cornell University Press
DOI:
10.7591/cornell/9780801449796.003.0004
Subject:
Sociology, Health, Illness, and Medicine

This chapter examines frauds instigated by major hospitals. A company's fixation on financial performance, especially bottom-line profits and stock market prices, may lead to overcharges, false ... More


The Major Health Care Fraud Laws

Terry L. Leap

in Phantom Billing, Fake Prescriptions, and the High Cost of Medicine: Health Care Fraud and What to Do about It

Published in print:
2011
Published Online:
August 2016
ISBN:
9780801449796
eISBN:
9780801460807
Item type:
chapter
Publisher:
Cornell University Press
DOI:
10.7591/cornell/9780801449796.003.0002
Subject:
Sociology, Health, Illness, and Medicine

This chapter discusses the major health care fraud laws in the United States. There are five laws that are specific to health care fraud and abuse: the 1972 anti-kickback statute, the Stark Law ... More


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