License To Steal: How Fraud Bleeds America's Health Care System, Updated Edition, 1st Edition (Paperback) book cover

License To Steal

How Fraud Bleeds America's Health Care System, Updated Edition, 1st Edition

By Malcolm K. Sparrow


240 pages

Purchasing Options:$ = USD
Paperback: 9780367159580
pub: 2020-03-30
Available for pre-order. Item will ship after 30th March 2020
Hardback: 9780367009717
pub: 2019-06-07
eBook (VitalSource) : 9780429039577
pub: 2019-03-13
from $24.98

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This book brings an unusual opportunity to explore the peculiarities of America's health care industry's approach to fraud control, when compared with the financial services sector, credit card companies, or the Internal Revenue Service—all of which have to defend themselves against fraud.

Table of Contents

Introduction Part One: Understanding the Fraud-Control Challenge 1. The Pathology of Fraud Control 2. Particular Challenges in the Health Care Field Insurers as Socially Acceptable Targets 3. The Importance of Measurement Quality Controls in Claims Processing 4. Assessment of Fraud-Control Systems Claims Processing 5. The Antithesis of Modern Claims Processing Background Part Two: Current Developments 6. Electronic Claims Processing two Views of EDI's Effects on Fraud 7. Managed Care Part Three: Prescription for Progress 8. A Model Fraud-Control Strategy Components of a Model Fraud-Control Strategy 9. Detection Systems Emphasis on Detection Tools 10. Conclusion

Subject Categories

BISAC Subject Codes/Headings:
SOCIAL SCIENCE / Sociology / General