License to Steal: Why Fraud Plagues America's Health Care System - Softcover

Sparrow, Malcolm K

Softcover

ISBN 10: 0813330688 ISBN 13: 9780813330686

Publisher: Westview Press, 1996

Synopsis

Criminal fraud must be factored into the current debates about health care reform, budget deficits, and proposed Medicare/Medicaid cutbacks. As a polity, how can we make good public policy if we don't know how much of the nation's one trillion dollar health care budget is being lost to fraud? The amounts are staggering, measured in hundreds of billions of dollars, but nobody knows for sure exactly how much is being lost.Malcolm Sparrow, an expert on fraud control, reviews how the health care industry approaches the problem and concludes that fraud is rampant, largely uncontrolled, and mostly invisible to policymakers. The problem will only get worse, he says, unless the industry at all levels changes its priorities, its strategies for uncovering and preventing fraud, and its technological approach.Many believe that electronic claims processing will save billions of dollars and that managed care will eliminate the major categories of fraud. By contrast, Sparrow shows how electronic claims processing could lead to unprecedented fraud losses, and how managed care makes fraud much more dangerous to human health.The final section—prescriptions for progress—is a must for policymakers at every level, and for anyone with an interest in the science of fraud control more broadly, in any context.

About this title

About the Author

Malcolm K. Sparrow teaches Regulatory and Enforcement Strategy, and Analytic Methods, at Harvard's John F. Kennedy School of Government. Formerly a Detective Chief Inspector with the British police service, he now specializes in issues of enforcement strategy, regulatory compliance, and risk control--he is the acknowledged national expert on the subject of Health Care Fraud. He is author of The Risk Business: Defining the Regulatory Craft (2000), License to Steal: Why Fraud Plagues America's Health Care System (1996), Imposing Duties: Government's Changing Approach to Compliance (1994); and co-author of B eyond 911: A New Era for Policing (1990) and Ethics in Government: The Moral Challenge for Public Leadership (1990).

From Booklist

One of the sidelights to the debate over health-care reform is the media attention, often sensational, devoted to fraud. Sparrow, a public-policy lecturer at Harvard's Kennedy School of Government and coauthor of a book about community policing entitled Beyond 911 (1990), contends that fraud in our health-care system is rampant. Despite his tabloidlike title, Sparrow takes a serious, often technocratic look at the industry's efforts at fraud control--and the lack thereof. He focuses on provider fraud as opposed to patient fraud, arguing that the former outpaces the latter by exponential proportions. He shows that most safeguards are designed to detect the abuse of overbilling rather than criminal fraud by those who "correctly" bill for procedures not even performed on patients who may not even exist. Sparrow also warns that electronic claims processing will worsen the problem because it will enable fraud to be committed faster, long before it can be detected. License to Steal adds an important dimension to the issue of health-care reform. David Rouse

About this edition

• Publisher: Westview Press
• Publication date: 1996
• ISBN 10: 0813330688
• ISBN 13: 9780813330686
• Binding: Paperback
• Edition number: 1
• Number of pages: 256