PRACTITIONER FRAUD AND ABUSE IN MEDICAL BENEFIT PROGRAMS: Government Regulation and Professional White‐Collar Crime

Pontell, Henry N.; Jesilow, Paul; Geis, Gilbert

doi:10.1111/j.1467-9930.1984.tb00335.x

Cited by 11 publications

(2 citation statements)

References 12 publications

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“…Similarly, Pontell, Jesilow and Geis (1984) noted the frauds committed by medical practitioners in the United States under the Medicare and Medicaid programs, in which practitioners were compensated for services supplied to patients. They report the occurrence of over-servicing, where patients are given treatment unnecessarily to claim fees, overcharging and bogus claims under the system.…”

Section: Subsidy Grant and Compensation Schemesmentioning

confidence: 98%

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Legislation and Unintended Consequences for Crime

Morgan

Clarke

2007

Eur J Crim Policy Res

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A literature review undertaken for the EU Crime Proofing Steering Group identified a set of legislative crime risk indicators. These are intended to assist in scanning summaries of new legislative proposals to identify regulation that might contribute to fraud, corruption, illegal trade, or environmental crime. The case studies reviewed suggest that any regulation carries the risk of such unintended crime consequences, which: (1) introduces product disposal requirements or any other new or more burdensome fee or obligation; (2) introduces a concession on a tax, or a concession on any other fee or obligation; (3) introduces a grant, subsidy, or compensation scheme; (4) introduces or increases the tax on legal goods, or in any other way increases the costs of legal goods; (5) prohibits or restricts a demanded product or service, or in any other way decreases the availability of demanded goods and services; (6) introduces or removes a law enforcement capacity, increases or decreases funding for enforcement activity or in any other way impacts the intensity of law enforcement activity; and (7) provides officials with regulatory power.

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Section: Subsidy Grant and Compensation Schemesmentioning

confidence: 98%

“…Firstly, Pontell et al (1984) and Wait (1997) noted the conflict of interests inherent in the U.S. Medicare and South Australian Workers Compensation Scheme, respectively. In both of these systems doctors treating patients were encouraged to abuse their position by over-servicing patients for the purposes of collecting fees.…”

Section: Empowering Regulationsmentioning

confidence: 99%

Legislation and Unintended Consequences for Crime

Morgan

Clarke

2007

Eur J Crim Policy Res

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Fraud by Physicians Against Medicaid

Jesilow

Geis²,

Pontell³

1991

JAMA

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The inauguration of the Medicaid program in the mid 1960s ultimately led to the appearance of a wide range of new forms of illegal behavior by physicians. The fact that government authorities, instead of individual patients, were responsible for payments undoubtedly encouraged the large number of violations. A review of the background of sanctioned physicians shows an overrepresentation of psychiatrists and foreign medical graduates as well as minority-group physicians. Interviews with physicians sanctioned for Medicaid fraud and abuse indicated that they routinely placed the blame for their violations on the program, their employees, patients, or others. In particular, they find program guidelines confusing and irrational and insist that they intrude on what ought to be independent medical judgments. The enforcers, for their part, maintain that the convicted physicians are merely rationalizing self-serving and greedy behavior.

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Examining the network components of a Medicare fraud scheme: the Mirzoyan-Terdjanian organization

Meyers

2017

Crime Law Soc Change

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PRACTITIONER FRAUD AND ABUSE IN MEDICAL BENEFIT PROGRAMS: Government Regulation and Professional White‐Collar Crime

Cited by 11 publications

References 12 publications

Legislation and Unintended Consequences for Crime

Legislation and Unintended Consequences for Crime

Fraud by Physicians Against Medicaid

Examining the network components of a Medicare fraud scheme: the Mirzoyan-Terdjanian organization

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