License to Steal: How Fraud Bleeds America's Health Care System

By Malcolm K. Sparrow | Go to book overview

NOTES

Preface
1.
Projections based upon the 1997 version of the "National Health Expenditures," released in November 1998 (i.e., last available). Source: Office of the Actuary, Health Care Financing Administration, Department of Health and Human Services, Washington, D.C.
2.
Information available to the public via WHO's Web site at http://www.who.int.
3.
"Swindles and Scams Rife in Health Insurance," Judith Randall. Book review of License to Steal: Why Fraud Plagues America's Health Care System, by Malcolm K. Sparrow. Washington Post, Health section, Tuesday, December 24, 1996, p. 1.
4.
"Foreword" by Donna Shalala, Semiannual Report, Department of Health and Human Services, Office of Inspector General, Washington, D.C., October 1, 1998--March 31, 1999.
5.
Press release, March 25, 1999, "Vice President Gore Announces New Efforts to Fight Health Care Fraud and Abuse," White House, Office of the Vice President, Washington, D.C.
6.
"What Do Americans Know About Health Care Fraud?" Lee Norrgard (Lead Investigative Specialist, American Association of Retired Persons). In Health Care Fraud Report, National Association of Attorneys General, Washington, D.C., September/ October 1997, pp. 8-10.
7.
Monthly Treasury Statement of Receipts and Outlays of the United States Government. Financial Management Service, U.S. Department of the Treasury. 1999 Annual Reports of the Board of Trustees of the HI and SMI Trust Funds. Office of the Actuary, Health Care Financing Administration, Department of Health and Human Services, Washington, D.C., Table 3.
8.
National Health Expenditures and Average Annual Percent Change, by Source of Funds: Selected Calendar Years 1970- 2008. Projections based upon the 1997 version of the National Health Expenditures, released in November 1998. Source: Office of the Actuary, Health Care Financing Administration, Department of Health and Human Services, Washington, D.C.
9.
"America Speaks Out on Health Care Fraud." A consumer survey conducted for the American Association of Retired Persons by International Communications Research Survey Research Group. American Association of Retired Persons, Washington, D.C., 1999.
10.
State of the Union address by President Clinton. House of Representatives, January 25, 1994. Comments regarding the need for health care reform.

-259-

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License to Steal: How Fraud Bleeds America's Health Care System
Table of contents

Table of contents

  • Title Page iii
  • Contents v
  • Preface vii
  • Introduction - Who Steals, and How? 1
  • Part One - The State of the Art 37
  • 1 - Control Failures 39
  • 2 - How Goes the War? 56
  • Part Two - New Frontiers for Control 81
  • 3 - False Claims 83
  • 4 - Managed Care 98
  • Part Three - The Nature of the Fraud-Control Challenge 115
  • 5 - The Pathology of Fraud Control 117
  • 6 - The Importance of Measurement 143
  • 7 - Assessment of Existing Fraud-Control Systems 162
  • 8 - The Antithesis of Modern Claims Processing 183
  • Part Four - Prescription for Progress 201
  • 9 - A Model Fraud-Control Strategy 203
  • 10 - Detection Systems 228
  • Conclusion 253
  • Acronyms and Abbreviations 257
  • Notes 259
  • Index 277
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