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| Document Type: | Book |
|---|---|
| All Authors / Contributors: |
Malcolm K Sparrow |
| ISBN: | 0813368103 9780813368108 |
| OCLC Number: | 43245549 |
| Description: | xx, 283 p. ; 24 cm. |
| Contents: | The State of the Art -- Control Failures -- How Goes the War? -- New Frontiers for Control -- False Claims -- Managed Care -- The Nature of the Fraud-Control Challenge -- The Pathology of Fraud Control -- The Importance of Measurement -- Assessment of Existing Fraud-Control Systems -- The Antithesis of Modern Claims Processing -- Prescription for Progress -- A Model Fraud-Control Strategy -- Detection Systems. |
| Responsibility: | Malcolm K. Sparrow. |
| More information: |
Abstract:
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 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.
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