Phantom Billing, Fake Prescriptions, and the High Cost of Medicine
U.S. health care is a $2.5 trillion system that accounts for
more than 17 percent of the nation's GDP. It is also highly
susceptible to fraud. Estimates vary, but some observers believe
that as much as 10 percent of all medical billing involves some
type of fraud. In 2009, New York's Medicaid fraud office recovered
$283 million and obtained 148 criminal convictions. In July 2010,
the U.S. Justice Department charged nearly 100 patients, doctors,
and health care executives in five states of bilking the Medicare
system out of more than $251 million through false claims for
services that were medically unnecessary or never provided. These
cases only hint at the scope of the problem.
In Phantom Billing, Fake Prescriptions, and the High Cost of
Medicine, Terry L. Leap takes on medical fraud and its
economic, psychological, and social costs. Illustrated throughout
with dozens of specific and often fascinating cases, this book
covers a wide variety of crimes: kickbacks, illicit referrals,
overcharging and double billing, upcoding, unbundling,
rent-a-patient and pill-mill schemes, insurance scams,
short-pilling, off-label marketing of pharmaceuticals, and rebate
fraud, as well as criminal acts that enable this fraud (mail and
wire fraud, conspiracy, and money laundering).
After assessing the effectiveness of the federal laws designed
to fight health care fraud and abuse-the antikickback statute, the
Stark Law, the False Claims Act, HIPAA, and the food and drug
laws-Leap suggests a number of ways that health care providers,
consumers, insurers, and federal and state officials can bring
health care fraud and abuse under control, thereby reducing the
overall cost of medical care in America.
Subjects: Health Sciences
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