医学顾问是有效应对保险欺诈和滥用行为的关键。

Medical consultant key to dealing effectively with insurance fraud and abuse.

作者信息

Taricco A

出版信息

Physician Exec. 1988 Sep-Oct;14(5):22-5.

Abstract

An unexpected, but everpresent, by-product of the development of the health care insurance industry is the tendency of those using the industry's services to "game" the system. While fraud and abuse in the claiming of insurance benefits are not the only or the most significant cause of steeply rising health care costs, they certainly contribute to the problem. Payers are advised to maintain a sharp eye for potential fraud and abuse and to observe some simple rules for detecting and eliminating them.

摘要

医疗保险行业发展过程中出现了一个意料之外却又始终存在的副产品，即使用该行业服务的人有“玩弄”系统的倾向。虽然在申领保险福利时的欺诈和滥用行为并非医疗保健成本急剧上升的唯一或最主要原因，但它们肯定加剧了这一问题。建议付款人密切留意潜在的欺诈和滥用行为，并遵循一些简单规则来发现和消除这些行为。