Know major reasons for why the healthcare system is unique in terms of WCC. -
ANSWER offenders are trained and trusted
victims don't have knowledge
highly self-regualted
Be familiar with following terms: fraud, abuse, Medicare, Medicaid -
ANSWER medicare-elderly
medicaid-poor
fraud: intentionally criminal behaviors by physicians
abuse: unintentional misuse of program funds
What is the most pervasive form of fraud in the healthcare system? -
ANSWER medicare/medicaid fraud
what factors make Medicare/Medicaid fraud more likely? - ANSWER government has
to pay out within 30 days
How do physicians engage in fraud and abuse? - ANSWER phantom treatment,
substitute providers, upcoding, falsifying records, unnecessary services, unbundling,
overcharging patients, ping pong and kickback schemes, ganging, co-pay waivers, medical
snowballing
1
, Know about medical malpractice and the term iatrogenic events - ANSWER the
distinction from fraud to malpractice is harm; events that cause more harm than good
He kept performing angiograms on people that did not need it - ANSWER He kept
performing angiograms on people that did not need it
What are the social/cultural contexts that make physician fraud more likely? -
ANSWER Victim vulnerability- uncertainty is the primary reason for medical
consultations
Patient/public demand for treatment- disease fear, physician trust (not insurance), faith in
system
Economic structure of system- "fee for service" rather than wellness outcomes
What did the Al-Jazeera documentary on pharmaceutical fraud suggest was a major form of
unethical or criminal behavior undertaken by large drug-making companies? -
ANSWER prescribing medication not approved for certain diseases
What are the consequences of medical malpractice, especially in terms of unnecessary
services? - ANSWER difficult to get good estimates because data primarily relies on
civil trials
Injuries and death
Depriving those truly in need
Wasted time of patients
Why do crimes by doctors get such little attention from criminologists, media, and general
public? - ANSWER because of the respect, power, and trust that the profession
engenders
What is the most pervasive form of fraud committed by doctors? - ANSWER Medicare
and Medicaid fraud and abuse
2
ANSWER offenders are trained and trusted
victims don't have knowledge
highly self-regualted
Be familiar with following terms: fraud, abuse, Medicare, Medicaid -
ANSWER medicare-elderly
medicaid-poor
fraud: intentionally criminal behaviors by physicians
abuse: unintentional misuse of program funds
What is the most pervasive form of fraud in the healthcare system? -
ANSWER medicare/medicaid fraud
what factors make Medicare/Medicaid fraud more likely? - ANSWER government has
to pay out within 30 days
How do physicians engage in fraud and abuse? - ANSWER phantom treatment,
substitute providers, upcoding, falsifying records, unnecessary services, unbundling,
overcharging patients, ping pong and kickback schemes, ganging, co-pay waivers, medical
snowballing
1
, Know about medical malpractice and the term iatrogenic events - ANSWER the
distinction from fraud to malpractice is harm; events that cause more harm than good
He kept performing angiograms on people that did not need it - ANSWER He kept
performing angiograms on people that did not need it
What are the social/cultural contexts that make physician fraud more likely? -
ANSWER Victim vulnerability- uncertainty is the primary reason for medical
consultations
Patient/public demand for treatment- disease fear, physician trust (not insurance), faith in
system
Economic structure of system- "fee for service" rather than wellness outcomes
What did the Al-Jazeera documentary on pharmaceutical fraud suggest was a major form of
unethical or criminal behavior undertaken by large drug-making companies? -
ANSWER prescribing medication not approved for certain diseases
What are the consequences of medical malpractice, especially in terms of unnecessary
services? - ANSWER difficult to get good estimates because data primarily relies on
civil trials
Injuries and death
Depriving those truly in need
Wasted time of patients
Why do crimes by doctors get such little attention from criminologists, media, and general
public? - ANSWER because of the respect, power, and trust that the profession
engenders
What is the most pervasive form of fraud committed by doctors? - ANSWER Medicare
and Medicaid fraud and abuse
2
