Abstract
There are numerous opportunities to commit fraud and corruption in government entitlement programs in the United States such as Medicare, social security, and unemployment benefit programs because of the complexity of these programs. State, federal, and local government agencies and private service agencies are involved in the administration and operations of the various programs. The oversight of the programs, in terms of having the mechanisms to detect fraud and corruption, is not always extensive enough to prevent the crimes committed by both the suppliers of the services and those who are the recipients of the benefits. In this chapter, fraud and corruption in the healthcare industry, in social security programs, and in government -sponsored programs pertaining to employment and unemployment are explored. The fraudulent activities of individuals receiving benefits, professionals, including doctors and pharmacists, suppliers of medical equipment and artificial body parts, government officials, as well as organized crime groups are explored. The strategies, programs, and techniques that are used by government law enforcement agencies and private investigative agencies to detect and prevent fraud in healthcare and related entitlement programs are described in the chapter.
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References
Association of Certified Fraud Examiners. (2017). 10 popular health care providers fraud schemes, pp. 1–7. http://www.acfe.com/article.aspx?id=4294976280. Retrieved 9/22/2017.
Baladerian, N., Coleman, T., & Stream, J. (2013). Abuse of people with disabilities: Victims and their families speak out. Spectrum Institute Disabilities and Abuse Project, pp. 1–4.
Centers for Disease Control and Prevention. (2017). Health care fraud, pp. 1–2. Retrieved 9/22/2017.
Coalition Against Insurance Fraud. (2014). Workers compensation scams. http://www.insurancefraud.org/scam-alert-workers-compensation.htm#UO21.RJufmv. Retrieved 6/15/2017.
Coalition Against Insurance Fraud. (2017). Report fraud. http://www.insurancefraud.org/report-fraud-htm. Retrieved 8/10/2017.
Columb, S. (2015). Beneath the organ trade: A critical analysis of the organ trafficking discourse. Crime, Law & Social Change, 63, 21–47.
Crimes Against Insurance Fraud. (2017). Report fraud. http://www.insurancefraud.org/report-fraud.htm, pp. 1–15. Retrieved 8/10/2017
Derrig, R. (2002). Insurance fraud. Journal of Risk and Insurance, 69(3), 271–287.
Edelbacher, M., & Theil, M. (2012). In M. Edelbacher, P. Kratcoski, & M. Theil (Eds.), White collar crime. Financial crimes: A threat to global security (pp. 100–117). Boca Raton, FL: CRC Press/Taylor & Francis Group.
FBI. (2015). Rooting out health insurance fraud is central to the well-being of both our citizens and the over-all economy. Health Care Fraud. http://www.fbi.gov/about-us/investigate/white_collar/health-care-fraud. Retrieved 9/1/2017.
Hunger Notes. (2016). Hunger in America: 2016 United States Hunger and Poverty Facts, pp. 1–5. http://www.worldhunger.org/hunger-in-america-2016-unites-states-hunger-poverty-facts/. Retrieved 7/21/2017.
Insurance Information Institute. (2014). Insurance fraud. http://www.iii.org/issue_update/insurance/fraud.html. Retrieved 6/15/2017.
Kasperkevic, J. (2014). How much can you get for selling your body (parts)? Guardian, pp. 1–5. https://www.theguardian.corn/money/us-money-blog/2014/jan/31/flu-government-sell-egg-sperm-body. Retrieved 10/10/2017.
Kratcoski, P. (2012). Legislative and programming initiatives to prevent and control financial crimes in the United States. Financial crimes: A threat to global security. In M. Edelbacher, P. Kratcoski, & M. Theil (Eds.), (pp. 373–389). Boca Raton, FL: CRC Press/Taylor and Francis Group.
Kratcoski, P., & Edelbacher, M. (2015). Investigation of insurance fraud. In J. Eterno & C. Roberson (Eds.), The detective handbook (pp. 67–86). Boca Raton, FL: CRC Press/Taylor &Francis Group.
Learn About the Law. (2017). Fraud, pp. 1–3. http://public.findlaw.com/pp.1-3. Retrieved 9/18/2017.
Legal Dictionary-Free Dictionary. (2017). Fraud- legal definition of fraud, pp. 1–5. http://legal-dictionary.the freedictionary.com/Fraud. Retrieved 9/18/2017.
Legal Information Institute (Cornell Law School). (2017a). Title 18, part I- U.S. code chapter 96- Racketeer influenced and corrupt organizations. https://www.law.cornell.edu/uscode/text/18/98. Retrieved 10/25/2017.
Legal Information Institute (Cornell Law School). (2017b). Title 18 U.S. code, chapter 47, section 1040-fraud in connection with major disaster or emergency benefits, p. 1. https://www.law.cornell.edu/uscode/text/18/1040. Retrieved 10/13/2017.
Legal Information Institute (Cornell Law School). (2017c). Title 18 U.S. code, chapter 47, section 1035- false statements relating to health care matters, p. 1. https://www.law.cornell.edu/uscode/text/18/1035. Retrieved 10/12/2017.
Morreale, S. (2015). Investigation of health care fraud. In J. Eterno & C. Roberson (Eds.), The detective handbook (pp. 99–116). Boca Raton, FL: CRC Press/Taylor & Francis Group.
National Health Care Anti- Fraud Association (NHCAA). (2014). http://www.nhcaa.org. Retrieved 10/5/2017.
Pianin, E. (2016). Why Social Security crackdown on disability fraud is coming up short. The fiscal times. http://www.thefiscaltimes.com/2016/03/14/Why-Social-Security-s-Crackdown-Disability-Fraud-Coming-Short. Retrieved 10/3/2017.
Price Waterhouse Coopers. (2014). Global economic crime survey, 2014. http://www.pwc.com/enGX/9X/economics-crime-survey/pdf/global-economic-crime-survey-2014. Retrieved 6/20/2017.
Small-Jordan (2016). Organ harvesting, human trafficking, and the black market, Recoded science, pp. 1–13. https://www.decodedscience.org/organ-harvesting-human-trafficking-black-market/56966. Retrieved 10/11/2017.
Social Security Disability Insurance Trust Fund Report (2017). http://www.ssa/gov/OACT/ProgData/describedi.htmi. Retrieved 10/26/2017.
Theoharis, M. (2017) Laws on federal fraud. Criminal defense lawyer, pp. 1–3. https://www.criminaldefenselawyer.com/crime-penalties/federal/federal-fraud.htm. Retrieved 10/13/2017.
UNBORN:USA. (2017). Under the radar: The lucrative sale of fetal body parts, pp. 1–2. http://www.unbornintheusa.org/pages/P_bodyparts.htm. Retrieved 10/10/2017.
US Government Accountability Office. (2016). Ten arrested for connection with insurance fraud August 2016. http://cypus-mail.com/2016/09/27/ten-arrested-connection-insurance-fraud. Retrieved 9/19/2017.
Wikipedia. (2017). Workers’ compensation. https://en.wikipedia.org/wili/Workers%27_compensation. Retrieved 10/4/2017.
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Kratcoski, P.C. (2018). Fraud and Corruption in the Healthcare Sector in the United States. In: Kratcoski, P., Edelbacher, M. (eds) Fraud and Corruption. Springer, Cham. https://doi.org/10.1007/978-3-319-92333-8_6
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DOI: https://doi.org/10.1007/978-3-319-92333-8_6
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