health care fraud


Also found in: Acronyms.

health care fraud

Deceptive, dishonest, and unlawful misrepresentations to a health insurer (such as Medicare) made by a provider or a patient in order to obtain money or services to which one is not entitled.
References in periodicals archive ?
The reasons for this failure are complex, and derive both from the factual context in which health care fraud occurs and from the traditional white collar crime enforcement framework.
What can CEOs do about health care fraud? We can provide leadership by taking a stand and setting examples.
This is followed by a chapter that describes the tremendous federal effort during the 1990s to combat health care fraud and the industry's response.
Not surprisingly, the Internet is emerging as a new venue for health care fraud. Darrell Langlois, deputy compliance officer for Blue Cross/Blue Shield of Louisiana in Baton Rouge, discussed one half-million-dollar scheme involving a psychologist who used the Internet to sell a "cure" to patients with chronic fatigue syndrome (CFS).
Clearly, the government's "war" on "health care fraud" continues to rage.
The federal government is assembling a growing army of attorneys, agents, analysts, and auditors to fight what is being called the crime of the '90s health care fraud. Armed with subpoenas, search warrants, and computers to analyze Medicare billing, it is clearly an uneven race against the provider.
Therefore, it focuses on the "weapons" available to the government in its battle against the perpetrators of health care fraud. Several new weapons were created through the enactment of the Health Insurance Portability and Accountability Act of 1996.
First, before we can attack the problem of health care fraud, we must be willing to commit the resources necessary to measure its prevalence.
has announced the release of CCH Health Care Fraud and Abuse on CD-ROM, a tool to assist and help ensure compliance for health-care providers, managed care organizations, physicians, and the professionals who advise them.
The Corning settlement included a $35 million criminal fine and an $84 million civil fine, together the largest ever in a health care fraud prosecution.
Related titles in the Health Law Library include: Health Care Fraud and Abuse, Patient Care Decision-Making, and The 1992 Health Law Handbook.
The prosecution of health care fraud is a fairly new endeavor.

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