1300 36 33 32

Who steals? An extraordinary range of folk--from low-life hoods who sign on as Medicare or Medicaid providers equipped with nothing more than beepers and mailboxes, to drug trafficking organizations, organized crime syndicates, and even major hospital chains. In License to Steal, Malcolm K. Sparrow shows how the industry's defenses, which focus mostly on finding and correcting billing errors, are no match for such well orchestrated attacks. The maxim for thieves simply becomes "bill your lies correctly." Provided they do that, fraud perpetrators with any degree of sophistication can steal millions of dollars with impunity, testing payment systems carefully, and then spreading fraudulent billings widely enough across patient and provider accounts to escape detection. The kinds of highly automated, quality controlled claims processing systems that pervade the industry present fraud perpetrators with their favorite kind of target: rich, fast paying, transparent, utterly predictable check printing systems, with little threat of human intervention, and with the U.S. Treasury on the end of the electronic line. Sparrow picks apart the industry's response to the government's efforts to control this problem. The provider associations (well heeled and politically influential) have vociferously opposed almost every recent enforcement initiative, creating the unfortunate public impression that the entire health care industry is against effective fraud control. A significant segment of the industry, it seems, regards fraud and abuse not as a problem, but as a lucrative enterprise worth defending. Meanwhile, it remains a perfectly commonplace experience for patients or their relatives to examine a medical bill and discover that half of it never happened, or that; likewise, if patients then complain, they discover that no one seems to care, or that no one has the resources to do anything about it.Sparrow's research suggests that the growth of capitated managed care systems does not solve the problem, as many in the industry had assumed, but merely changes its form. The managed care environment produces scams involving underutilization, and the withholding of medical care schemes that are harder to uncover and investigate, and much more dangerous to human health. Having worked extensively with federal and state officials since the appearance of his first book on this subject, Sparrow is in a unique position to evaluate recent law enforcement initiatives. He admits the "war on fraud" is at least now engaged, but it is far from won.

Buy License to Steal book by Malcolm K. Sparrow from Australia's Online Bookstore, Boomerang Books.

Book Details

ISBN: 9780813368108
ISBN-10: 0813368103
Format: Hardback
(229mm x 153mm x 25mm)
Pages: 304
Imprint: Basic Books
Publisher: The Perseus Books Group
Publish Date: 19-May-2000
Country of Publication: United States

Reviews

» Have you read this book? We'd like to know what you think about it - write a review about License to Steal book by Malcolm K. Sparrow and you'll earn 50c in Boomerang Bucks loyalty dollars (you must be a member - it's free to sign up!)

Write Review


Author Biography - Malcolm K. Sparrow

Malcolm K. Sparrow teaches Regulatory and Enforcement Strategy, and Analytic Methods, at Harvard's John F. Kennedy School of Government. Formerly a Detective Chief Inspector with the British police service, he now specializes in issues of enforcement strategy, regulatory compliance, and risk control--he is the acknowledged national expert on the subject of Health Care Fraud. He is author of The Risk Business: Defining the Regulatory Craft (2000), License to Steal: Why Fraud Plagues America's Health Care System (1996), Imposing Duties: Government's Changing Approach to Compliance (1994); and co-author of Beyond 911: A New Era for Policing (1990) and Ethics in Government: The Moral Challenge for Public Leadership (1990).

Books By Author Malcolm K. Sparrow

Handcuffed by Malcolm K. Sparrow

Handcuffed

Hardback, March 2016
$43.56
Character of Harms by Malcolm K. Sparrow

The Character of Harms

Hardback, April 2008
$48.56
Regulatory Craft by Malcolm K. Sparrow

The Regulatory Craft

Paperback, May 2000
$42.26
Beyond 911 by Malcolm K. Sparrow

Beyond 911

Paperback, June 1992
$28.75