Prevention and Control of Fraud: A Case Study of the Medicaid Program

Each case study focuses on the information needed to detect accurately patterns of misuse of Medicaid funds by health care providers and to prosecute those cases where investigation establishes that a pattern of potentially fraudulent activity exists. These cases illustrate the prerequisites for developing proactive fraud prevention strategies that are designed to identify program weaknesses as well as detect fraudulent abuse. Charts and tables are given. References are provided with individual case studies.