License to Steal: Updated Edition by Malcolm K SparrowLicense to Steal: Updated Edition by Malcolm K Sparrow

License to Steal: Updated Edition

byMalcolm K Sparrow

Hardcover | June 9, 2000

Pricing and Purchase Info

$28.35 online 
$31.50 list price save 10%
Earn 142 plum® points

Prices and offers may vary in store

Quantity:

In stock online

Ships free on orders over $25

Not available in stores

about

Who steals? An extraordinary range of folk--from low-life hoods who sign on as Medicare or Medicaid providers equipped with nothing more than beepers and mailboxes, to drug trafficking organizations, organized crime syndicates, and even major hospital chains. InLicense to Steal, Malcolm K. Sparrow shows how the industry's defenses, which focus mostly on finding and correcting billing errors, are no match for such well orchestrated attacks. The maxim for thieves simply becomes "bill your lies correctly." Provided they do that, fraud perpetrators with any degree of sophistication can steal millions of dollars with impunity, testing payment systems carefully, and then spreading fraudulent billings widely enough across patient and provider accounts to escape detection. The kinds of highly automated, quality controlled claims processing systems that pervade the industry present fraud perpetrators with their favorite kind of target: rich, fast paying, transparent, utterly predictable check printing systems, with little threat of human intervention, and with the U.S. Treasury on the end of the electronic line. Sparrow picks apart the industry's response to the government's efforts to control this problem. The provider associations (well heeled and politically influential) have vociferously opposed almost every recent enforcement initiative, creating the unfortunate public impression that the entire health care industry is against effective fraud control. A significant segment of the industry, it seems, regards fraud and abuse not as a problem, but as a lucrative enterprise worth defending. Meanwhile, it remains a perfectly commonplace experience for patients or their relatives to examine a medical bill and discover that half of it never happened, or that; likewise, if patients then complain, they discover that no one seems to care, or that no one has the resources to do anything about it.Sparrow's research suggests that the growth of capitated managed care systems does not solve the problem, as many in the industry had assumed, but merely changes its form. The managed care environment produces scams involvingunderutilization, and the withholding of medical care schemes that are harder to uncover and investigate, and much more dangerous to human health. Having worked extensively with federal and state officials since the appearance of his first book on this subject, Sparrow is in a unique position to evaluate recent law enforcement initiatives. He admits the "war on fraud" is at least now engaged, but it is far from won.
Malcolm K. Sparrowteaches Regulatory and Enforcement Strategy, and Analytic Methods, at Harvard's John F. Kennedy School of Government. Formerly a Detective Chief Inspector with the British police service, he now specializes in issues of enforcement strategy, regulatory compliance, and risk control--he is the acknowledged national expe...
Loading
Title:License to Steal: Updated EditionFormat:HardcoverDimensions:304 pages, 9 × 6 × 0.99 inPublished:June 9, 2000Publisher:Basic BooksLanguage:English

The following ISBNs are associated with this title:

ISBN - 10:0813368103

ISBN - 13:9780813368108

Reviews

From Our Editors

Malcolm Sparrow has written a shocking expose of the United States health system’s terrible weaknesses. License to Steal: How Fraud Bleeds America’s Health Care System – Updated Edition explains how criminals scam approximately 100 billion dollars every year. Fully automated check printing systems are largely to blame, and Sparrow demonstrates how and why. Drug trafficking organizations, crime syndicates, independent operators and even major hospital chains are culprits in this terrible swindle. Find out how this problem can be stopped with License to Steal.