Tackling healthcare fraud
Aiming to contain vast and fast-rising expenditure levels estimated to amount to 8.2% of GDP across OECD countries in 2003, national healthcare reforms cannot avoid rationing, that is withholding beneficial interventions from needy individuals. Yet, a substantial part of a nation’s healthcare spending is typically diverted in illicit ways–rendering otherwise feasible care unattainable and undermining the legitimacy of private and public services. In the US healthcare fraud and abuse reportedly accounts for around 10% of total outlays, i.e., $120 billion per year. In the UK prescription crime in 2003 was estimated to amount to £115 million. In Lower Saxony, one of Germany’s 16 Länder, insurance fraud alone accounted for €40 million in 2003. But cases are not always clear-cut and not always easily dealt with. There is often substantial ambiguity in defining what is actually improper conduct, identifying such behavior among vast numbers of cases that are handled annually, telling errors apart from criminal intent, and choosing adequate regulatory responses. This case can be used in conjunction with IMD-3-1464, IMD-3-1465, and IMD-3-1466.
2003/2004
Cranfield University
Wharley End Beds MK43 0JR, UK
Tel +44 (0)1234 750903
Email [email protected]
Harvard Business School Publishing
60 Harvard Way, Boston MA 02163, USA
Tel (800) 545-7685 Tel (617)-783-7600
Fax (617) 783-7666
Email [email protected]
NUCB Business School
1-3-1 Nishiki Naka
Nagoya Aichi, Japan 460-0003
Tel +81 52 20 38 111
Email [email protected]
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