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License to steal : how fraud bleeds America's health care system

Author: Malcolm K Sparrow
Publisher: Boulder, Colo. : Westview Press, 2000.
Edition/Format:   Book : English : Updated edView all editions and formats
Summary:
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  Read more...
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Details

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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