Healthcare fraud under the microscope: improving its prevention

Abstract

PurposeThe purpose of this paper is to make readers aware of the extensiveness of healthcare fraud in the USA and how it involves and affects the government, healthcare providers, insurance companies, patients and the public. In addition, recommendations are made that may help control this pervasive type of fraud.Design/methodology/approachA range of different journal publications, information from government health institutions and law enforcement websites, healthcare fraud cases and healthcare laws are used as a basis to provide information about how fraudsters are committing healthcare fraud and how to prevent this fraud from occurring.FindingsDespite increased funding and prosecution efforts by the government, healthcare fraud continues to be a major threat to the US economy and public. While healthcare fraud will never be eradicated, specific efforts can be deployed to help rein in these complex fraud schemes.Practical implicationsThe paper provides a useful resource of information on healthcare fraud for healthcare providers, insurance companies, patients and the public that may help combat healthcare fraud and prevent financial losses.Social implicationsEvery dollar saved from combating fraud could be used to improve access to more or better health services and can, thereby, save lives.Originality/valueThis paper provides recommendations regarding healthcare fraud that could help prevent this large drain on the US economy.