Criminal Prosecution As A Deterrent To Health Care Fraud

Criminal prosecution as a deterrent to health care fraud : hearing before the Subcommittee on Crime and Drugs of the Committee on the Judiciary, United States Senate, One Hundred Eleventh Congress, first session, May 20, 2009.

Criminal prosecution as a deterrent to health care fraud: hearing before the Subcommittee on Crime and Drugs of the Committee on the Judiciary, United States Senate, One Hundred Eleventh Congress, first session, May 20, 2009.

Health Care Fraud: Enforcement and Compliance focuses on fraud and abuse issues involving health care providers as well as application of the laws governing fraud and abuse to manufacturers of drugs and medical devices and other non-providers such as medical researchers.

The concept of deviance is complex, given that norms vary considerably across groups, times, and places. Society tends to primarily recognize traditional portraits of deviants such as street-offenders and drug addicts. The label "deviant" is commonly cast upon society’s undesirables, but this socially constructed image often overlooks subtler—and arguably more dangerous—deviance. Physician malfeasance is an especially problematic form, given that medical professionals garner trust, autonomy, and prestige from society, which allows them to operate outside of the public eye. This book responds to a growing number of concerns regarding deviant physician actions such as physically and sexually abusive behaviors, fabricating medical findings and records, and taking advantage of patients (e.g., filing fraudulent Medicaid claims). It explores theoretical explanations for physician deviance, and goes on to consider potential responses such as Medicaid Fraud Control Units, the Questionable Doctors database, and the ability of doctors to police themselves. The unique perspective offered in this book informs discussions of white-collar crime and deviance and has important implications for researchers, policymakers, and students involved in criminal justice and public policy.

Over the past couple of decades, individuals have come to rely more on home health care visits for their health care needs. While there have been decreases in hospital stays and in the percentage of older persons living in nursing homes the consequence has been the emergence of a new type of occupational crime: home health care abuse. In considering offending in the home health care industry, it is important to focus on crimes by and against home health care professionals. This book is one of the first to fully address abuses occurring in the home health care industry. Its intent is not to suggest that home health care is a dangerous field for workers and consumers; rather, the intent is to shed some light on the types of misconduct found in home health care. Each chapter will include a wealth of examples to illustrate that these incidents actually are real, devastating, and significant. At the end of each chapter the reader will find a series of discussion questions designed to encourage the reader to reflect back on the content of the chapter through the eyes of those involved in the response to home health care fraud. Also included are Web site addresses where readers can learn more about the offenses and other resources to help demonstrate ways to deal with the problem. It is intended for criminal justice officials, health care professionals, academics, and researchers who want to better understand the nature of offending in the home health care industry. It is also intended for use in criminal justice, sociology, and white-collar crime courses exploring crime in the workplace as well as courses examining the home health care field. Chapters include: Home, Home on the Range: Where Health Care is Provided and Crimes are Committed; Home Health Care Professionals as Victims and Witnesses; Crimes by Home Health Professionals: Violence, Theft, and Deception; Responding to Crime in the Home Health Care Field: Strategies, Obstacles, and Issues; and Preventing Home Health Care Misconduct.