8/29/2011

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

License to Steal: Why Fraud Plagues America's Health Care System
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The first edition of License to Steal woke up the people in charge of healthcare payment in America. Sparrow brought attention to the scope and nature of the healthcare fraud problem. And the scope is huge--he estimates that hundreds of billions of dollars are lost to healthcare fraud each year.
In the wake of Sparrow's book, Medicare, Medicaid, HMOs and insurers started to take fraud more seriously. Sparrow's 2000 edition of License to Steal includes information on fraud efforts since the first edition and how they are still falling far short of what is needed to limit fraud to an acceptable level. Spend the extra few dollars to get the updated hardcover edition.
Robin Mathias, MPA, Fraud Bulldog
Mathias Consulting
http://www.....com

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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.

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