Logo Oapen
  • Search
  • Join
    • Deposit
    • For Librarians
    • For Publishers
    • For Researchers
    • Funders
    • Resources
    • OAPEN
    • For Librarians
    • For Publishers
    • For Researchers
    • Funders
    • Resources
    • OAPEN
    View Item 
    •   OAPEN Home
    • View Item
    •   OAPEN Home
    • View Item
    JavaScript is disabled for your browser. Some features of this site may not work without it.

    Phantom Billing, Fake Prescriptions, and the High Cost of Medicine

    Health Care Fraud and What to Do about It

    Thumbnail
    Download PDF Viewer
    Download
    Web Shop
    Author(s)
    Leap, Terry L.
    Language
    English
    Show full item record
    Abstract
    U.S. health care is a $2.5 trillion system that accounts for more than 17 percent of the nation’s GDP. It is also highly susceptible to fraud. Estimates vary, but some observers believe that as much as 10 percent of all medical billing involves some type of fraud. In 2009, New York’s Medicaid fraud office recovered $283 million and obtained 148 criminal convictions. In July 2010, the U.S. Justice Department charged nearly 100 patients, doctors, and health care executives in five states of bilking the Medicare system out of more than $251 million through false claims for services that were medically unnecessary or never provided. These cases only hint at the scope of the problem. In Phantom Billing, Fake Prescriptions, and the High Cost of Medicine, Terry L. Leap takes on medical fraud and its economic, psychological, and social costs. Illustrated throughout with dozens of specific and often fascinating cases, this book covers a wide variety of crimes: kickbacks, illicit referrals, overcharging and double billing, upcoding, unbundling, rent-a-patient and pill-mill schemes, insurance scams, short-pilling, off-label marketing of pharmaceuticals, and rebate fraud, as well as criminal acts that enable this fraud (mail and wire fraud, conspiracy, and money laundering). After assessing the effectiveness of the federal laws designed to fight health care fraud and abuse—the antikickback statute, the Stark Law, the False Claims Act, HIPAA, and the food and drug laws—Leap suggests a number of ways that health care providers, consumers, insurers, and federal and state officials can bring health care fraud and abuse under control, thereby reducing the overall cost of medical care in America.
    URI
    https://library.oapen.org/handle/20.500.12657/62116
    Keywords
    kickbacks, illicit referrals, overcharging and double billing, upcoding, unbundling, rent-a-patient, pill-mill schemes, insurance scams, short-pilling, off-label marketing, pharmaceuticals, rebate fraud
    DOI
    10.7298/wszs-bn07
    ISBN
    9780801460807, 9780801461286, 9780801449796, 9780801460807, 9780801461286
    Publisher
    Cornell University Press
    Publisher website
    https://www.cornellpress.cornell.edu/
    Publication date and place
    Ithaca, 2011
    Grantor
    • National Endowment for the Humanities - [...] - CARES
    Imprint
    ILR Press
    Classification
    Medicolegal issues
    Pages
    256
    Rights
    https://creativecommons.org/licenses/by-nc-nd/4.0/
    • Imported or submitted locally

    Browse

    All of OAPENSubjectsPublishersLanguagesCollections

    My Account

    LoginRegister

    Export

    Repository metadata
    Logo Oapen
    • For Librarians
    • For Publishers
    • For Researchers
    • Funders
    • Resources
    • OAPEN

    Newsletter

    • Subscribe to our newsletter
    • view our news archive

    Follow us on

    License

    • If not noted otherwise all contents are available under Attribution 4.0 International (CC BY 4.0)

    Credits

    • logo EU
    • This project received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 683680, 810640, 871069 and 964352.

    OAPEN is based in the Netherlands, with its registered office in the National Library in The Hague.

    Director: Niels Stern

    Address:
    OAPEN Foundation
    Prins Willem-Alexanderhof 5
    2595 BE The Hague
    Postal address:
    OAPEN Foundation
    P.O. Box 90407
    2509 LK The Hague

    Websites:
    OAPEN Home: www.oapen.org
    OAPEN Library: library.oapen.org
    DOAB: www.doabooks.org

     

     

    Export search results

    The export option will allow you to export the current search results of the entered query to a file. Differen formats are available for download. To export the items, click on the button corresponding with the preferred download format.

    A logged-in user can export up to 15000 items. If you're not logged in, you can export no more than 500 items.

    To select a subset of the search results, click "Selective Export" button and make a selection of the items you want to export. The amount of items that can be exported at once is similarly restricted as the full export.

    After making a selection, click one of the export format buttons. The amount of items that will be exported is indicated in the bubble next to export format.