The Big Picture
The Big Picture
This book explores one serious social problem that is costing U.S. consumers and taxpayers billions of dollars a year: health care fraud and abuse. It examines whether the current definitions of “fraud” and “abuse” are too broad, and whether certain institutional arrangements such as fee-for-service systems or capitation plans are more (or less) conducive to fraud and abuse. It also assesses the effectiveness of the current laws and regulations for fighting health care fraud, the role of for-profit health care in reducing fraud, and what health care arrangements, financial incentives, and technologies can be used to curb fraud and abuse. This introduction provides an overview of the causes of health care fraud and abuse, along with its salient features and dynamics. In particular, it considers the similarities of health care fraud and abuse to other white-collar crimes and suggests that health care fraud is ever changing as perpetrators make adjustments.
Keywords: health care fraud, fee-for-service systems, capitation plans, for-profit health care, health care, financial incentives, white-collar crime
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