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Phantom Billing, Fake Prescriptions, and the High Cost of MedicineHealth Care Fraud and What to Do about It$
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Terry L. Leap

Print publication date: 2011

Print ISBN-13: 9780801449796

Published to Cornell Scholarship Online: August 2016

DOI: 10.7591/cornell/9780801449796.001.0001

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Health Care Fraud and Its Facilitating Crimes

Health Care Fraud and Its Facilitating Crimes

Chapter:
(p.21) 1 Health Care Fraud and Its Facilitating Crimes
Source:
Phantom Billing, Fake Prescriptions, and the High Cost of Medicine
Author(s):

Terry L. Leap

Publisher:
Cornell University Press
DOI:10.7591/cornell/9780801449796.003.0001

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 such as billing errors, and the conditions required to prove fraud. It then discusses the so-called “object crimes” such as filing phony insurance claims, making false diagnoses and unnecessary treatments, organizing a rent-a-patient scheme, or promoting the illegal off-label use of a drug. The crimes that support or enable the object crimes are known as auxiliary or facilitative crimes; examples are conspiracy, money laundering, tax evasion, mail and wire fraud, lying to federal authorities, perjury, and obstruction of justice. The chapter also explains how the Racketeering Influenced and Corrupt Organizations (RICO) Act, enacted primarily to combat organized crime, can be used not only to pursue the mob's entrance into the health care arena but also against health care institutions, pharmaceutical manufacturers, and health insurers.

Keywords:   health care fraud, object crimes, facilitative crimes, conspiracy, money laundering, tax evasion, mail fraud, perjury, obstruction of justice, Racketeering Influenced and Corrupt Organizations Act

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