Fraud and Corruption in the Healthcare Sector in the United States

Abstract

There are numerous opportunities to commit fraud and corruption in government entitlement programs in the United States such as Medicare, social security, and unemployment benefit programs because of the complexity of these programs. State, federal, and local government agencies and private service agencies are involved in the administration and operations of the various programs. The oversight of the programs, in terms of having the mechanisms to detect fraud and corruption, is not always extensive enough to prevent the crimes committed by both the suppliers of the services and those who are the recipients of the benefits. In this chapter, fraud and corruption in the healthcare industry, in social security programs, and in government -sponsored programs pertaining to employment and unemployment are explored. The fraudulent activities of individuals receiving benefits, professionals, including doctors and pharmacists, suppliers of medical equipment and artificial body parts, government officials, as well as organized crime groups are explored. The strategies, programs, and techniques that are used by government law enforcement agencies and private investigative agencies to detect and prevent fraud in healthcare and related entitlement programs are described in the chapter.