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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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Fighting Health Care Fraud and Abuse

Fighting Health Care Fraud and Abuse

(p.144) 6 Fighting Health Care Fraud and Abuse
Phantom Billing, Fake Prescriptions, and the High Cost of Medicine

Terry L. Leap

Cornell University Press

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 commit a criminal or corrupt act and goes on to consider strategies for dealing with health care providers involved in fraudulent activities, along with antifraud measures taken by private health insurers. It then stresses the importance of educating health care consumers to protect them against health care scam artists and dishonest providers. It also examines the role of federal and state governments in the fight against health care fraud, with particular emphasis on the Centers for Medicare and Medicaid Services, and explains how health care fraud and abuse cases are investigated and prosecuted. The chapter concludes with a brief overview of the Federal Sentencing Guidelines for various crimes, including white-collar crimes such as health care fraud.

Keywords:   health care fraud, corruption, private health insurers, health care consumers, Medicare, Medicaid, Centers for Medicare and Medicaid Services, Federal Sentencing Guidelines, white-collar crime, health care providers

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