License To Steal: How Fraud bleeds america's health care system [Hardcover]

Malcolm K Sparrow (Author)

Book Description

ISBN-10: 0813368103 | ISBN-13: 978-0813368108 | Publication Date: June 9, 2000 | Edition: Updated

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. In License 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 involving underutilization, 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.

Editorial Reviews

About the Author

Malcolm K. Sparrow teaches 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 expert on the subject of Health Care Fraud. He is author of The Risk Business: Defining the Regulatory Craft (2000), License to Steal: Why Fraud Plagues America's Health Care System (1996), Imposing Duties: Government's Changing Approach to Compliance (1994); and co-author of Beyond 911: A New Era for Policing (1990) and Ethics in Government: The Moral Challenge for Public Leadership (1990).

Product Details

• Hardcover: 304 pages
• Publisher: westview press; Updated edition (June 9, 2000)
• Language: English
• ISBN-10: 0813368103
• ISBN-13: 978-0813368108
• Product Dimensions: 9.1 x 6.2 x 1 inches
• Shipping Weight: 1.2 pounds (View shipping rates and policies)
• Average Customer Review: 4.2 out of 5 stars  See all reviews (5 customer reviews)
• Amazon Best Sellers Rank: #436,869 in Books (See Top 100 in Books)
  • #89 in Books > Medical Books > Administration & Medicine Economics > Health Care Administration

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Customer Reviews

Most Helpful Customer Reviews

11 of 11 people found the following review helpful:

5.0 out of 5 stars Straight talk on fraud, September 1, 2000

By 

J. Brodnicki "HypnoJoe" (Hendersonville, TN USA) - See all my reviews
(REAL NAME)   

This review is from: License To Steal: How Fraud bleeds america's health care system (Hardcover)

Although he has a wealth of expertise and a scholar's background, Sparrow speaks in a narrative style about the sad state of health care fraud in America today. While some progress is being made, there remains a little depth and sophistication in the responses to the complex and clever fraud schemes out there. Regretably, the many policitcal and institutional barriers to mesuring and uncovering fraud continue to allow the system to be drained of precious dollars. While it takes a large investment to begin the fight on the level Sparrow advocates, the return is immeasurably greater. Not recommended for folks who don't need their blood pressure to rise.

4 of 4 people found the following review helpful:

5.0 out of 5 stars Must read for fraud investigators, November 3, 2006

By 

A. Tassin "ATassin" (Sacramento, CA) - See all my reviews
(REAL NAME)   

This review is from: License To Steal: How Fraud bleeds america's health care system (Hardcover)

This text is the best high level review of the national health care fraud issue out there. It gives the first time health care fraud professional the basics. It is somewhat dated in 2006, but nevertheless a very informative read on the subject.

5 of 6 people found the following review helpful:

5.0 out of 5 stars Finally, someone who "gets it"!!!, September 15, 2002

By 

Valerie Aarne (Rochester, NY USA) - See all my reviews

This review is from: License To Steal: How Fraud bleeds america's health care system (Hardcover)

This is a remarkable book which opens the readers eyes to some of the "real" issues in the financial state of healthcare in the United States. It pulls together what the people in the trenches have struggled with for years ... and puts it into an easy to read text that you just CAN'T put down. This should be required text for anyone working in healthcare or anyone who receives care from the system.