Problems controlling fraud and abuse in the home health care field

Abstract

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.

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

“…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).…”

“…Kickbacks involve the solicitation or compensation for products or services for which Medicaid reimburses the provider (Hyman 2001). Kickbacks can also involve instances where a provider receives some sort of payment for referring a patient to another provider (Payne 2006).…”

“…Medicare is a federally operated program that provides access to health care for individuals who are disabled and=or elderly while Medicaid is a state program that provides health care coverage for certain groups of low-income individuals (Payne 2012). Although the health care programs provide millions of individuals with invaluable services, they are highly susceptible to deviance by health care providers.…”

“…The Medicare and Medicaid programs were created to provide health care for the elderly and poor (Iglehart 2001;Payne 2006;Rowland and Garfield 2000). Medicare is a federally operated program that provides access to health care for individuals who are disabled and=or elderly while Medicaid is a state program that provides health care coverage for certain groups of low-income individuals (Payne 2012).…”

Criminological Theory and Elder Abuse Research—Fruitful Relationship or Worlds Apart?

“…They connect the presence of motivated offenders to caregiving strain, low job satisfaction, perceived unfairness of working conditions and nurses' low self-control. Payne and Fletcher (2005) and Payne andGainey (2006, 2007) also have taken a routine activities perspective on abuse in institutional care. Payne (2006) and Setterlund et al (2007) have applied RAT concepts to financial elder abuse, Dietz and Wright (2005) to the topic of victimization of older homeless people.…”