Problems controlling fraud and abuse in the home health care field. Voices of fraud control unit directors
| Date | 01 January 2006 |
| Pages | 77-91 |
| Published date | 01 January 2006 |
| DOI | https://doi.org/10.1108/13590790610641260 |
| Author | Brian K. Payne |
| Subject Matter | Accounting & finance |
Problems controlling fraud and
abuse in the home health care field
Voices of fraud control
unit directors
Brian K. Payne
Sociology and Criminal Justice, Old Dominion University,
Norfolk, Virginia, USA
Abstract
Purpose – The purpose of the current study is to assess the efforts to control fraud in the home
health care industry in the USA by examining the problems that criminal justice officials confronted in
their attempts to control home health care fraud and abuse.
Design/methodology/approach – Attention is given to the history of the home health care
industry in the USA, the types of fraud found in the health care field in general, and the officials who
are given the duty of controlling health care fraud.
Findings – The results of this study suggest that the problems fraud control officials face in their
response to home health care offenders are similar to those confronted in the response to white-collar
offending, but also similar to those confronted in the response to many conventional offenses.
Originality/value – Highlights the problems in controlling fraud and abuse in the US home care
health field.
Keywords Fraud, Home care,Health services, United States of America
Paper type Research paper
Introduction
In 1965, President Lyndon Johnson signed legislation creating the Medicaid and
Medicare programs. Medicare operates at the federal level and exists to provide
health care to the elderly and disabled adults. Medicaid, on the other hand, operates
at the state level and provides access to health care for the poor. Both programs are
at the center of much debate, especially during election years when the fate of the
programs seems to be dubious. Less often considered by policy makers and the
voting public, but very much a problem, is fraud and abuse in the government
health care programs.
A group of researchers (Geis et al., 1985; Jesilow et al., 1985, 1995; Pontell et al., 1982)
have considered several studies on health care fraud and abuse. Generally spe aking,
fraud refers to criminal acts in which health care providers intentionally steal from
Medicare or Medicaid whereas abuse entails situations in which inappropriate billing
by health care providers are defined as unintentional actions. Three themes arise from
this health care fraud research.
First, the research suggests that health care fraud is extremely pervasive and costly
to society. While researchers have not been able to determine the precise extent of
The current issue and full text archive of this journal is available at
www.emeraldinsight.com/1359-0790.htm
The author would like to thank Crystal Carey and Randy Gainey for their input on an earlier
draft of this paper.
Voices of fraud
control unit
directors
77
Journal of Financial Crime
Vol. 13 No. 1, 2006
pp. 77-91
qEmerald Group Publishing Limited
1359-0790
DOI 10.1108/13590790610641260
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