License to steal: why fraud plagues America's health care system
Cover -- Half Tilte -- Title -- Copyright -- Contents -- Foreword -- Preface -- Acknowledgments -- Introduction -- PART ONE Understanding the Fraud-Control Challenge -- 1 The Pathology of Fraud Control -- Essential Character of Fraud Control -- What Constitutes an Effective Fraud-Control System? --...
Gespeichert in:
| 1. Verfasser: | |
|---|---|
| Weitere Verfasser: | |
| Format: | Buch |
| Sprache: | English |
| Veröffentlicht: |
London ; New York
Routledge
2018
|
| Schlagworte: | |
| Zusammenfassung: | Cover -- Half Tilte -- Title -- Copyright -- Contents -- Foreword -- Preface -- Acknowledgments -- Introduction -- PART ONE Understanding the Fraud-Control Challenge -- 1 The Pathology of Fraud Control -- Essential Character of Fraud Control -- What Constitutes an Effective Fraud-Control System? -- How Bad Can Things Get Before the System Responds? -- 2 Particular Challenges In the Health Care Field -- Insurers as Socially Acceptable Targets -- Health Care Fraud Schemes Not Self-Revealing -- Separation Between Administrative Budget and "Funds -- Respectability of the Health Care Profession -- Unclear Distinctions Between Fraud, Abuse, Overutilization, and Other Activities -- 3 The Importance of Measurement -- Quality Controls in Claims Processing -- Surveys of Fraud Cases -- Random Mailing of EOMBs -- Implications of the Absence of Measurement -- How Measurement Changes the Nature of the Discussion-Fraud in the IRS Refund Program -- Why Measurement Is Not Done -- Resource Allocation, in the Absence of Measurement -- 4 Assessment of Fraud-Control Systems -- Claims Processing -- Claims Examination and Development -- Prepayment Medical Review -- An Experiment in Automated "Claims Examination -- Surprising Lack of Fraud Awareness -- Post-Utilization Review -- Audits -- Special Investigative Units -- Lack of Coordinated Control Strategy -- 5 The Antithesis of Modern Claims Processing -- Background -- Evidence of Success -- What Company X Does Differently -- Lessons for the Industry -- PART TWO Current Developments -- 6 Electronic Claims Processing -- Two Views of EDI's Effects on Fraud -- Popular Misconceptions -- Prosecutorial Difficulties -- Detection Difficulties -- Absence of Common Sense in Claims Reviews -- Three New Threats -- Can Technology Provide Appropriate Safeguards? -- Automated Prevention": A Fatally Flawed Vision |
| Beschreibung: | First published 1996 by Westview Press |
| Beschreibung: | xv, 240 Seiten |
| ISBN: | 9780367009717 9780367159580 |
Internformat
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| 520 | 3 | |a Cover -- Half Tilte -- Title -- Copyright -- Contents -- Foreword -- Preface -- Acknowledgments -- Introduction -- PART ONE Understanding the Fraud-Control Challenge -- 1 The Pathology of Fraud Control -- Essential Character of Fraud Control -- What Constitutes an Effective Fraud-Control System? -- How Bad Can Things Get Before the System Responds? -- 2 Particular Challenges In the Health Care Field -- Insurers as Socially Acceptable Targets -- Health Care Fraud Schemes Not Self-Revealing -- Separation Between Administrative Budget and "Funds -- Respectability of the Health Care Profession -- Unclear Distinctions Between Fraud, Abuse, Overutilization, and Other Activities -- 3 The Importance of Measurement -- Quality Controls in Claims Processing -- Surveys of Fraud Cases -- Random Mailing of EOMBs -- Implications of the Absence of Measurement -- How Measurement Changes the Nature of the Discussion-Fraud in the IRS Refund Program -- Why Measurement Is Not Done -- Resource Allocation, in the Absence of Measurement -- 4 Assessment of Fraud-Control Systems -- Claims Processing -- Claims Examination and Development -- Prepayment Medical Review -- An Experiment in Automated "Claims Examination -- Surprising Lack of Fraud Awareness -- Post-Utilization Review -- Audits -- Special Investigative Units -- Lack of Coordinated Control Strategy -- 5 The Antithesis of Modern Claims Processing -- Background -- Evidence of Success -- What Company X Does Differently -- Lessons for the Industry -- PART TWO Current Developments -- 6 Electronic Claims Processing -- Two Views of EDI's Effects on Fraud -- Popular Misconceptions -- Prosecutorial Difficulties -- Detection Difficulties -- Absence of Common Sense in Claims Reviews -- Three New Threats -- Can Technology Provide Appropriate Safeguards? -- Automated Prevention": A Fatally Flawed Vision | |
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Datensatz im Suchindex
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| author | Sparrow, Malcolm K. 1956- |
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| discipline | Soziologie Wirtschaftswissenschaften |
| discipline_str_mv | Soziologie Wirtschaftswissenschaften |
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| spelling | Sparrow, Malcolm K. 1956- Verfasser (DE-588)1105073645 aut License to steal why fraud plagues America's health care system Malcom K. Sparrow ; with a foreword by Lawton Chiles London ; New York Routledge 2018 xv, 240 Seiten txt rdacontent n rdamedia nc rdacarrier First published 1996 by Westview Press Cover -- Half Tilte -- Title -- Copyright -- Contents -- Foreword -- Preface -- Acknowledgments -- Introduction -- PART ONE Understanding the Fraud-Control Challenge -- 1 The Pathology of Fraud Control -- Essential Character of Fraud Control -- What Constitutes an Effective Fraud-Control System? -- How Bad Can Things Get Before the System Responds? -- 2 Particular Challenges In the Health Care Field -- Insurers as Socially Acceptable Targets -- Health Care Fraud Schemes Not Self-Revealing -- Separation Between Administrative Budget and "Funds -- Respectability of the Health Care Profession -- Unclear Distinctions Between Fraud, Abuse, Overutilization, and Other Activities -- 3 The Importance of Measurement -- Quality Controls in Claims Processing -- Surveys of Fraud Cases -- Random Mailing of EOMBs -- Implications of the Absence of Measurement -- How Measurement Changes the Nature of the Discussion-Fraud in the IRS Refund Program -- Why Measurement Is Not Done -- Resource Allocation, in the Absence of Measurement -- 4 Assessment of Fraud-Control Systems -- Claims Processing -- Claims Examination and Development -- Prepayment Medical Review -- An Experiment in Automated "Claims Examination -- Surprising Lack of Fraud Awareness -- Post-Utilization Review -- Audits -- Special Investigative Units -- Lack of Coordinated Control Strategy -- 5 The Antithesis of Modern Claims Processing -- Background -- Evidence of Success -- What Company X Does Differently -- Lessons for the Industry -- PART TWO Current Developments -- 6 Electronic Claims Processing -- Two Views of EDI's Effects on Fraud -- Popular Misconceptions -- Prosecutorial Difficulties -- Detection Difficulties -- Absence of Common Sense in Claims Reviews -- Three New Threats -- Can Technology Provide Appropriate Safeguards? -- Automated Prevention": A Fatally Flawed Vision Delivery of Health Care United States Fraud United States Medical care Corrupt practices United States Medicare fraud Scientific Misconduct United States Kriminalität (DE-588)4033178-7 gnd rswk-swf Gesundheitswesen (DE-588)4020775-4 gnd rswk-swf USA USA (DE-588)4078704-7 gnd rswk-swf USA (DE-588)4078704-7 g Gesundheitswesen (DE-588)4020775-4 s Kriminalität (DE-588)4033178-7 s DE-604 Chiles, Lawton Mainor 1930-1998 (DE-588)1195198019 aui Erscheint auch als Online-Ausgabe, PDF 978-0-429-70108-5 Erscheint auch als Online-Ausgabe, EPUB 978-0-429-72109-0 |
| spellingShingle | Sparrow, Malcolm K. 1956- License to steal why fraud plagues America's health care system Delivery of Health Care United States Fraud United States Medical care Corrupt practices United States Medicare fraud Scientific Misconduct United States Kriminalität (DE-588)4033178-7 gnd Gesundheitswesen (DE-588)4020775-4 gnd |
| subject_GND | (DE-588)4033178-7 (DE-588)4020775-4 (DE-588)4078704-7 |
| title | License to steal why fraud plagues America's health care system |
| title_auth | License to steal why fraud plagues America's health care system |
| title_exact_search | License to steal why fraud plagues America's health care system |
| title_exact_search_txtP | License to steal why fraud plagues America's health care system |
| title_full | License to steal why fraud plagues America's health care system Malcom K. Sparrow ; with a foreword by Lawton Chiles |
| title_fullStr | License to steal why fraud plagues America's health care system Malcom K. Sparrow ; with a foreword by Lawton Chiles |
| title_full_unstemmed | License to steal why fraud plagues America's health care system Malcom K. Sparrow ; with a foreword by Lawton Chiles |
| title_short | License to steal |
| title_sort | license to steal why fraud plagues america s health care system |
| title_sub | why fraud plagues America's health care system |
| topic | Delivery of Health Care United States Fraud United States Medical care Corrupt practices United States Medicare fraud Scientific Misconduct United States Kriminalität (DE-588)4033178-7 gnd Gesundheitswesen (DE-588)4020775-4 gnd |
| topic_facet | Delivery of Health Care United States Fraud United States Medical care Corrupt practices United States Medicare fraud Scientific Misconduct United States Kriminalität Gesundheitswesen USA |
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