McGee Jamie, Sandridge Leslie, Treadway Cierra, Vance Kimberly, Coustasse Alberto
Author Affiliations: Lewis College of Business, Marshall University, South Charleston, West Virginia.
Health Care Manag (Frederick). 2018 Apr/Jun;37(2):147-154. doi: 10.1097/HCM.0000000000000204.
In 2014, the United States spent approximately $3 trillion on health care. Medicare accounted for $554 billion of these costs, and approximately $60 billion were squandered because of incorrect billing methods, abuse, and fraud. Types of fraud included kickbacks, upcoding, and organized fraudulent crimes. To reduce the financial burden associated with these activities, the United States has created various fraud prevention programs. The purpose of this study was to identify methods of Medicare fraud, examine the various programs implemented by the US government to combat fraud and abuse, and determine the effectiveness of these programs. Although fraud prevention strategies have proven to be effective, the furtherance of these strategies is imperative to continually combat rising health care expenditures in the United States. Benefits of increased fraud prevention and detection are discussed in detail.
2014年，美国在医疗保健方面支出约3万亿美元。医疗保险占这些费用的5540亿美元，约600亿美元因计费方式不当、滥用和欺诈行为而被浪费。欺诈类型包括回扣、提高编码以及有组织的欺诈犯罪。为减轻与这些活动相关的财务负担，美国设立了各种欺诈预防计划。本研究的目的是确定医疗保险欺诈的方法，研究美国政府为打击欺诈和滥用行为而实施的各种计划，并确定这些计划的有效性。尽管欺诈预防策略已被证明是有效的，但必须推进这些策略，以持续应对美国不断上涨的医疗保健支出。文中详细讨论了加强欺诈预防和侦查的好处。
