Pies H E
Am J Law Med. 1977 Fall;3(3):323-32.
This Comment explores issues concerning the control of fraud and abuse in health programs financed with public funds, specifically the Medicare and Medicaid programs. It summarizes the nature, scope, and possible causes of what some regard as a fraud and abuse "crisis," and points out the difficulties and obstacles facing those who attempt to develop legislative and executive action aimed at controlling fraud and abuse. Recent federal initiatives in fraud and abuse control are examined, and a brief summary of key provisions of H.R. 3 (the Medicare-Medicaid Anti-fraud and Abuse Amendments, which may prove to be a landmark piece of legislation in this area) is provided. The author emphasizes that more effective control of fraud and abuse is necessary if further expansion of government financing of health programs, including national health insurance, is to occur in the near future. At the same time, caution must be taken not to neglect the appropriate use of other mechanisms necessary for reducing the costs of medical care and improving its quality. In addition, it is likely that efforts to stem fraud and abuse will raise important medicolegal and public policy issues that will require careful interdisciplinary consideration.
本评论探讨了与公共资金资助的医疗项目（特别是医疗保险和医疗补助项目）中的欺诈和滥用行为控制相关的问题。它总结了一些人所认为的欺诈和滥用“危机”的性质、范围及可能原因，并指出了那些试图制定旨在控制欺诈和滥用行为的立法及行政措施的人所面临的困难和障碍。审查了近期联邦政府在欺诈和滥用行为控制方面的举措，并简要概述了众议院第3号法案（《医疗保险 - 医疗补助反欺诈和滥用修正案》，这可能成为该领域具有里程碑意义的一项立法）的关键条款。作者强调，如果近期要进一步扩大政府对医疗项目（包括国家医疗保险）的资助，就必须更有效地控制欺诈和滥用行为。与此同时，必须谨慎行事，不要忽视使用其他降低医疗成本和提高医疗质量所需的适当机制。此外，遏制欺诈和滥用行为的努力可能会引发重要的法医学和公共政策问题，需要进行仔细的跨学科考量。
