A Demographic Portrait of Physicians Sanctioned by the Federal Government for Fraud and Abuse Against Medicare and Medicaid

Pontell, Henry N.; Jesilow, Paul; Geis, Gilbert; O’Brien, Mary Jane

doi:10.1097/00005650-198508000-00010

Cited by 13 publications

(25 citation statements)

References 6 publications

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“…It is important to note that researchers acknowledge that not all physicians engage in fraud, but a small minority are responsible for a great deal of fraudulent behavior (Morris 2009;Pontell et al 1984Pontell et al , 1985Payne and Gray 2001). Pontell and colleagues (1982) identified a variety of fraudulent behaviors committed by physicians.…”

Section: Literature Reviewmentioning

confidence: 99%

“…In particular, mental health professionals, namely psychologists and psychiatrists, comprise a disproportionate amount of Medicaid and Medicare fraud perpetrators (Geis et al 1985a;Pontell et al 1985;Payne 1995). A study by Geis and colleagues found that psychiatrists made up over 18% of those sanctioned for a Medicaid and=or Medicare violation (Geis et al 1985a;Pontell et al 1985).…”

Section: Literature Reviewmentioning

confidence: 99%

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An Examination of Deviance and Deviants in the Durable Medical Equipment (DME) Field: Characteristics, Consequences, and Responses to Fraud

Policastro

Payne

2012

Deviant Behavior

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The literature indicates Medicaid fraud is pervasive and comprises a substantial portion of health care spending. One type of Medicaid fraud that has not been explored is durable medical equipment fraud. This study seeks to fill this gap in the literature by examining the characteristics of durable medical equipment fraud cases investigated by Medicaid Fraud Control Units. Content analysis was used to review 258 reported cases of durable medical equipment fraud. The findings indicate that providers engage in a range of offenses and are subject to a variety of sanctions. Policy implications and recommendations for future research are provided.

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Section: Literature Reviewmentioning

confidence: 99%

Section: Literature Reviewmentioning

confidence: 99%

An Examination of Deviance and Deviants in the Durable Medical Equipment (DME) Field: Characteristics, Consequences, and Responses to Fraud

Policastro

Payne

2012

Deviant Behavior

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“…Previous studies of physician fraud and other exclusions from Medicare rely on older data 7 , 8 , 9 and do not include sufficient comparisons of the characteristics of excluded and nonexcluded physicians. 7 , 8 , 9 , 10 , 11 Published studies of board disciplined physicians were limited to case studies from specific states.…”

Section: Introductionmentioning

confidence: 99%

Characteristics of Physicians Excluded From US Medicare and State Public Insurance Programs for Fraud, Health Crimes, or Unlawful Prescribing of Controlled Substances

2018

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Key Points Question What were the characteristics of physicians who have been excluded from US Medicare and state public insurance programs? Findings In this cross-sectional study assessing all physician exclusions from 2007 to 2017, the number of physician exclusions grew by 20% per year (equivalent to 48 additional exclusions per year) to encompass approximately 0.3% of US physicians in 2017. Exclusions were more common in the West and Southeast census regions, and male physicians, physicians with osteopathic training, older physicians, and physicians in specific specialties (eg, family medicine, psychiatry, internal medicine, anesthesiology, surgery, and obstetrics/gynecology) were more likely to be excluded. Meaning The likelihood of exclusion varied across regions and with physician demographics and specialty.

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“…A group of researchers (Geis et al , 1985; Jesilow et al , 1985, 1995; Pontell et al , 1982) have considered several studies on health care fraud and abuse. Generally speaking, fraud refers to criminal acts in which health care providers intentionally steal from Medicare or Medicaid whereas abuse entails situations in which inappropriate billing by health care providers are defined as unintentional actions.…”

Section: Introductionmentioning

confidence: 99%

“…Second, some suggest that the costs of Medicaid and Medicare fraud extend far beyond the economic losses (Pontell et al , 1982). For example, the deprivation of trust is one loss that results from health care misdeeds.…”

Section: Introductionmentioning

confidence: 99%

Problems controlling fraud and abuse in the home health care field

Payne

2006

Journal of Financial Crime

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PurposeThe purpose of the current study is to assess the efforts to control fraud in the home health care industry in the USA by examining the problems that criminal justice officials confronted in their attempts to control home health care fraud and abuse.Design/methodology/approachAttention is given to the history of the home health care industry in the USA, the types of fraud found in the health care field in general, and the officials who are given the duty of controlling health care fraud.FindingsThe results of this study suggest that the problems fraud control officials face in their response to home health care offenders are similar to those confronted in the response to white‐collar offending, but also similar to those confronted in the response to many conventional offenses.Originality/valueHighlights the problems in controlling fraud and abuse in the US home care health field.

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A Demographic Portrait of Physicians Sanctioned by the Federal Government for Fraud and Abuse Against Medicare and Medicaid

Cited by 13 publications

References 6 publications

An Examination of Deviance and Deviants in the Durable Medical Equipment (DME) Field: Characteristics, Consequences, and Responses to Fraud

An Examination of Deviance and Deviants in the Durable Medical Equipment (DME) Field: Characteristics, Consequences, and Responses to Fraud

Characteristics of Physicians Excluded From US Medicare and State Public Insurance Programs for Fraud, Health Crimes, or Unlawful Prescribing of Controlled Substances

Problems controlling fraud and abuse in the home health care field

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