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Cover Art
Author Sparrow, Malcolm K.

Title License to steal : how fraud bleeds America's health care system / Malcolm K. Sparrow.

Published Boulder, CO : Westview Press, 2000.


Location Call No. Status
 UniM Bail  362.10973 SPAR    AVAILABLE
Edition Updated ed.
Physical description 283 pages ; 24 cm
Bibliography Includes bibliographical references and index.
Contents Part 1 State of the Art -- 1 Control Failures 39 -- 2 How Goes the War? 56 -- Part 2 New Frontiers for Control -- 3 False Claims 83 -- 4 Managed Care 98 -- Part 3 Nature of the Fraud-Control Challenge -- 5 Pathology of Fraud Control 117 -- 6 Importance of Measurement 143 -- 7 Assessment of Existing Fraud-Control Systems 162 -- 8 Antithesis of Modern Claims Processing 183 -- Part 4 Prescription for Progress -- 9 A Model Fraud-Control Strategy 203 -- 10 Detection Systems 228.
Summary Fraud and abuse bleeds more than 100 billion dollars each year out of the U.S. health system. This detailed examination shows the problem is worse than almost anyone knows, mostly invisible, and still far from controlled. Sparrow reveals that current control systems fail by presenting fraud perpetrators with a safe, easy-to-hit target: fully automated check-printing systems, which only require thieves to bill "correctly", regardless of whether or not any medical service is provided. This target attracts an extraordinary range of criminal entrepreneurs, from low-life hoods who sign on as Medicare or Medicaid providers equipped with nothing more than beepers and mailboxes, to drug trafficking organizations, organized crime syndicates, even major hospital chains. Sparrow's research examines the much-misunderstood effects of managed care on the problem, the government's recent attempts to grapple with fraud, and the campaign by various provider associations to undermine those efforts.
Subject Medical care -- Corrupt practices -- United States.
Medicare fraud.
Medicaid fraud.
ISBN 0813368103 (alk. paper)