Nelson K M, Lieberman J A
Palmetto Government Benefits Administrators, Columbia, SC, USA.
Physician Exec. 1997 Feb;23(2):27-9.
Fraud and abuse, which can occur in all industries, also exist in the health care industry. This problem is compounded by the reality that "American medicine, although undergoing evolution, now faces changes of a magnitude that has never before been encountered." These changes are creating new realities for physician executives and also new challenges. As there are changes in business practices, there will be changes in how fraud occurs in health care. Physician executives need to be sensitive to the possibility of fraud and abuse as an unwanted component in medical losses in managed care systems.
欺诈和滥用行为存在于所有行业,医疗保健行业也不例外。“美国医学尽管在不断发展,但如今面临着前所未有的巨大变革”,这一现实使问题更加复杂。这些变革给医师管理人员带来了新的现实情况,也带来了新的挑战。随着商业行为的变化,医疗保健领域欺诈行为的发生方式也会改变。医师管理人员需要敏锐地意识到,欺诈和滥用行为可能成为管理式医疗系统中医疗损失的一个不良组成部分。