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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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The Big Picture

The Big Picture

Chapter:
(p.1) Introduction The Big Picture
Source:
Phantom Billing, Fake Prescriptions, and the High Cost of Medicine
Author(s):

Terry L. Leap

Publisher:
Cornell University Press
DOI:10.7591/cornell/9780801449796.003.0008

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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