The Resource License To Steal : Updated Edition, (electronic resource)

License To Steal : Updated Edition, (electronic resource)

Label
License To Steal : Updated Edition
Title
License To Steal
Title remainder
Updated Edition
Creator
Subject
Genre
Language
  • eng
  • eng
Summary
An explanation of how thieves exploit the U.S. health system and steal more than 100 billion each year
Cataloging source
AU-PeEL
http://library.link/vocab/creatorName
Sparrow, Malcolm K
Dewey number
362.10973
Language note
English
LC call number
RA395.A3 S764
Nature of contents
dictionaries
http://library.link/vocab/subjectName
  • Medical care -- Corrupt practices -- United States
  • Medicare fraud
  • Medical care
  • Medicare fraud
  • Medicaid fraud
  • Medical Assistance
  • Insurance
  • Legislation as Topic
  • Crime
  • Health Care Quality, Access, and Evaluation
  • Patient Care Management
  • Social Control, Formal
  • Public Assistance
  • Criminology
  • Health Services Administration
  • Health Care
  • Financing, Organized
  • Financing, Government
  • Health Care Economics and Organizations
  • Economics
  • Social Sciences
  • Anthropology, Education, Sociology and Social Phenomena
  • Medicaid
  • Fraud
  • Medicare
  • Delivery of Health Care
  • Managed Care Programs
  • Insurance, Health
Label
License To Steal : Updated Edition, (electronic resource)
Instantiates
Publication
Note
Description based upon print version of record
Carrier category
online resource
Carrier category code
cr
Content category
text
Content type code
txt
Contents
  • Cover Page; Title Page; Copyright Page; Preface; The Industry Perspective; The Administration's Perspective; The Consumer's Perspective; Decision Point; Acknowledgments; Introduction: Who Steals, and How?; Fictitious Companies; Generalists; Physicians; Dentists; Largest Corporations; Columbia/HCA; Laboratories; Teaching Hospitals; Billing Specialists; Organized Crime; Meat, for Money; Cooperating Patients; Communities and Networks; No Meat, Faster Money; Fifteen Million in a Day; Part One: The State of the Art; 1 Control Failures; Two Distinct Sciences: Fraud Detection and Utilization Review
  • Find a Weakness and Exploit It MercilesslyWhat is "Control"?; Rotten Segments, Sluggish Response; The Nature of the Response; 2 How Goes the War?; Counterattack; The Hospitals and the Battle over the False Claims Act; By the Numbers; Count the Zeroes; Medicare Contractors; Medicaid Operations at the State Level; How Goes the War?; Part Two: New Frontiers for Control; 3 False Claims; The Consumer's Perspective; The Medicare Overpayment Measurement Studies; Fraud Audits; The Industry's Perspective on False Claims; 4 Managed Care; Expansion of Managed Care; Major Types of Managed Care Plans
  • Structural Solution to the Fraud Problem?Early Experience; More Recent Experience Within the Medicaid Program; Potential Frauds Committed Against Managed Care Plans; Fraud and Abuse Committed by the Plans; Difficulties with Detection of Underutilization; Shifting Locus for Fraud; Shifting Locus for Fraud Control; Corporate Middlemen Not Bound by Professional Ethics; Reevaluating the Health Care Consequences of Fraud; Part Three: The Nature of the Fraud-Control Challenge; 5 The Pathology of Fraud Control; Essential Character of Fraud Control
  • Overreliance upon Traditional Enforcement ApproachesParticular Challenges in the Health Gare Field; 6 The Importance of Measurement; How Measurement Changes the Nature of the Discussion-Fraud in the Irs Refund Program; Why Measurement is Not Generally Done; Early Attempts at Measurement; Resource Allocation, in the Absence of Measurement; 7 Assessment of Existing Fraud-Control Systems; Claims Processing; Claims Examination and Development; Prepayment Medical Review; An Experiment in Automated "Claims Examination"; Surprising Lack of Fraud Awareness; Postutilization Review; Audits
  • Special Investigative UnitsLack of Coordinated Control Strategy; 8 The Antithesis of Modern Claims Processing; Background; Evidence of Success; What Company X Does Differently; Single Point-of-Contact Service for Customers; Fraud-Control Philosophy; Attitudes Toward Technology; Lessons for the Industry; Part Four: Prescription for Progress; 9 A Model Fraud-Control Strategy; Components of a Model Fraud-Control Strategy; Applicability to Managed Care; The Prospects for Implementation; 10 Detection Systems; The Multilevel Nature of Fraud Control; The Seven Levels of Health Care Fraud Control
  • The Current Emphasis
Dimensions
unknown
Extent
1 online resource (343 p.)
Form of item
electronic
Isbn
9780786723706
Media category
computer
Media type code
c
Specific material designation
remote
System control number
  • (CKB)1000000000475807
  • (EBL)904162
  • (OCoLC)818855242
  • (SSID)ssj0000191957
  • (PQKBManifestationID)12030211
  • (PQKBTitleCode)TC0000191957
  • (PQKBWorkID)10186537
  • (PQKB)10013162
  • (EXLCZ)991000000000475807
Label
License To Steal : Updated Edition, (electronic resource)
Publication
Note
Description based upon print version of record
Carrier category
online resource
Carrier category code
cr
Content category
text
Content type code
txt
Contents
  • Cover Page; Title Page; Copyright Page; Preface; The Industry Perspective; The Administration's Perspective; The Consumer's Perspective; Decision Point; Acknowledgments; Introduction: Who Steals, and How?; Fictitious Companies; Generalists; Physicians; Dentists; Largest Corporations; Columbia/HCA; Laboratories; Teaching Hospitals; Billing Specialists; Organized Crime; Meat, for Money; Cooperating Patients; Communities and Networks; No Meat, Faster Money; Fifteen Million in a Day; Part One: The State of the Art; 1 Control Failures; Two Distinct Sciences: Fraud Detection and Utilization Review
  • Find a Weakness and Exploit It MercilesslyWhat is "Control"?; Rotten Segments, Sluggish Response; The Nature of the Response; 2 How Goes the War?; Counterattack; The Hospitals and the Battle over the False Claims Act; By the Numbers; Count the Zeroes; Medicare Contractors; Medicaid Operations at the State Level; How Goes the War?; Part Two: New Frontiers for Control; 3 False Claims; The Consumer's Perspective; The Medicare Overpayment Measurement Studies; Fraud Audits; The Industry's Perspective on False Claims; 4 Managed Care; Expansion of Managed Care; Major Types of Managed Care Plans
  • Structural Solution to the Fraud Problem?Early Experience; More Recent Experience Within the Medicaid Program; Potential Frauds Committed Against Managed Care Plans; Fraud and Abuse Committed by the Plans; Difficulties with Detection of Underutilization; Shifting Locus for Fraud; Shifting Locus for Fraud Control; Corporate Middlemen Not Bound by Professional Ethics; Reevaluating the Health Care Consequences of Fraud; Part Three: The Nature of the Fraud-Control Challenge; 5 The Pathology of Fraud Control; Essential Character of Fraud Control
  • Overreliance upon Traditional Enforcement ApproachesParticular Challenges in the Health Gare Field; 6 The Importance of Measurement; How Measurement Changes the Nature of the Discussion-Fraud in the Irs Refund Program; Why Measurement is Not Generally Done; Early Attempts at Measurement; Resource Allocation, in the Absence of Measurement; 7 Assessment of Existing Fraud-Control Systems; Claims Processing; Claims Examination and Development; Prepayment Medical Review; An Experiment in Automated "Claims Examination"; Surprising Lack of Fraud Awareness; Postutilization Review; Audits
  • Special Investigative UnitsLack of Coordinated Control Strategy; 8 The Antithesis of Modern Claims Processing; Background; Evidence of Success; What Company X Does Differently; Single Point-of-Contact Service for Customers; Fraud-Control Philosophy; Attitudes Toward Technology; Lessons for the Industry; Part Four: Prescription for Progress; 9 A Model Fraud-Control Strategy; Components of a Model Fraud-Control Strategy; Applicability to Managed Care; The Prospects for Implementation; 10 Detection Systems; The Multilevel Nature of Fraud Control; The Seven Levels of Health Care Fraud Control
  • The Current Emphasis
Dimensions
unknown
Extent
1 online resource (343 p.)
Form of item
electronic
Isbn
9780786723706
Media category
computer
Media type code
c
Specific material designation
remote
System control number
  • (CKB)1000000000475807
  • (EBL)904162
  • (OCoLC)818855242
  • (SSID)ssj0000191957
  • (PQKBManifestationID)12030211
  • (PQKBTitleCode)TC0000191957
  • (PQKBWorkID)10186537
  • (PQKB)10013162
  • (EXLCZ)991000000000475807

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