Healthcare fraud under the microscope: improving its prevention

Nicole F. Stowell, Martina Schmidt and Nathan Wadlinger

Journal of Financial Crime, 2018, vol. 25, issue 4, 1039-1061

Abstract: Purpose - The purpose of this paper is to make readers aware of the extensiveness of healthcare fraud in the USA and how it involves and affects the government, healthcare providers, insurance companies, patients and the public. In addition, recommendations are made that may help control this pervasive type of fraud. Design/methodology/approach - A range of different journal publications, information from government health institutions and law enforcement websites, healthcare fraud cases and healthcare laws are used as a basis to provide information about how fraudsters are committing healthcare fraud and how to prevent this fraud from occurring. Findings - Despite increased funding and prosecution efforts by the government, healthcare fraud continues to be a major threat to the US economy and public. While healthcare fraud will never be eradicated, specific efforts can be deployed to help rein in these complex fraud schemes. Practical implications - The paper provides a useful resource of information on healthcare fraud for healthcare providers, insurance companies, patients and the public that may help combat healthcare fraud and prevent financial losses. Social implications - Every dollar saved from combating fraud could be used to improve access to more or better health services and can, thereby, save lives. Originality/value - This paper provides recommendations regarding healthcare fraud that could help prevent this large drain on the US economy.

Keywords: False claims act; Anti-Kickback statute; Healthcare fraud; Medical identity theft; medicare and medicaid; stark law (search for similar items in EconPapers)
Date: 2018
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Citations: View citations in EconPapers (1)

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Persistent link: https://EconPapers.repec.org/RePEc:eme:jfcpps:jfc-05-2017-0041

DOI: 10.1108/JFC-05-2017-0041

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