SAGE Journal Articles

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Payne, B. K. & Gray, C. (2001). Fraud by Home Health Care Workers and the Criminal Justice Response. Criminal Justice Review, 26(2), 209-232. 

Summary: Research in the medical literature suggests that the investigation of fraud in the home health care field grew significantly throughout the 1990s. Although criminologists have examined health care fraud by physicians, virtually no criminological research has assessed crime within the home hath care industry. This article attempts to fill that void by considering the kinds of home health care offenses that are investigated by fraud control units throughout the United States. Content analysis is performed on 247 reported incidents of home health cue abuses. Finding indicate that home health care professionals commit offenses that are similar to, yet different from, those that are committed by doctors. The importance of community service as a sanction for these offenders, and the need for background checks, are considered. Support for conflict theory and general systems theory emerges as well.

Questions to consider:

  1. What are the seven forms of Medicaid fraud discussed in this article?
     
  2. How has the criminal justice system reacted to Medicaid fraud?
     
  3. What did the authors find to be the most common form of Medicaid fraud?
     

Jesilow, P. (2012). Is Sweden Doomed to Reproduce U.S. Errors? Fraud in Sweden’s Health Care System. International Criminal Justice Review 22 (1), 24-42/

Summary: Frauds committed by recipients of public insurance and providers of health care are stealing millions of kronor from Swedish taxpayers each year. Privatization in Sweden’s health care will likely increase the losses from fraud. Vårdval, Sweden’s latest method to transfer the delivery of health services from public entities to private ones, focuses on primary care and is an attempt to secure “seamless” treatment for patients at a nearby location and hopefully reduce health care costs. But the new policy also creates numerous opportunities for unscrupulous providers and patients to steal from Sweden’s taxpayer-supported programs. The intent of the current research was to explore the impacts of privatization on the regulation of Swedish health care. One of those impacts, it is argued, will be a need for Swedish officials to attend to a growing crime problem. Lessons from the United States suggest that government attention to the problem at this early stage is needed to prevent the thefts from growing and becoming a major drain on Sweden’s budget, as they are in the United States.

Questions to consider:

  1. How have the challenges faced in the United States provide strategies for the Swedish government to follow to prevent fraud?
     
  2. Describe how fraud health care fraud occurs in the Swedish system? Is this similar or different to how fraud occurs in the United States?
     
  3. Is there any strategy to completely eliminate fraud in health care or given the nature of the health care system both domestically and internationally, will it always  be a challenge?