Tulli C G
J Health Hum Resour Adm. 1987 Spring;9(4):470-86.
In summary, a public policy to get rid of practitioner fraud and abuse has been established. It resulted initially from the changing attitude of the electorate on spending for social as well as health service programs. It is reflected by the congressional enactment of new laws against practitioner fraud and abuse, i.e., the Medicare-Medicaid Anti-Fraud and Abuse Amendments of 1977 and the Civil Money Penalties Law of 1981. It has been implemented through the prosecution of numerous practitioners involved in fraudulent activities and abuses using the new laws as well as many others, including the False Claims Act of 1963 and the fraud penalties codes recognized under the Federal Old Age, Survivors and Disability Insurance Act. The ultimate success of this public policy, however, will certainly depend, at least in part, on our ability to obtain an objective and realistic analysis of the degree of fraud and abuse in these programs, as well as to define the characteristics of "Medical Mills" and to determine to what extent they still exist. Finally, if this public policy is to mature, it must follow a path that assures that we do not disrupt or hamper the delivery of health care services to our poor and elderly populations through the needless introduction of regulatory requirements or legal excesses.
总之，一项旨在消除从业者欺诈和滥用行为的公共政策已经确立。它最初源于选民对社会及医疗服务项目支出态度的转变。这体现在国会颁布的针对从业者欺诈和滥用行为的新法律中，即1977年的《医疗保险 - 医疗补助反欺诈和滥用修正案》以及1981年的《民事罚款法》。该政策已通过利用这些新法律以及许多其他法律，包括1963年的《虚假索赔法》和《联邦老年、遗属及残疾保险法》所认可的欺诈处罚法规，对众多参与欺诈活动和滥用行为的从业者提起诉讼得以实施。然而，这项公共政策的最终成功肯定至少部分取决于我们能否对这些项目中的欺诈和滥用程度进行客观、现实的分析，界定“医疗作坊”的特征，并确定它们仍然存在的程度。最后，如果这项公共政策要走向成熟，它必须遵循一条确保我们不会因不必要地引入监管要求或法律过度干预而扰乱或妨碍向贫困和老年人群体提供医疗服务的道路。
