The effects of the fraud and abuse enforcement program under the National Health Insurance program in Korea

Kang, Hee-Chung; Hong, Jae-Seok; Lee, Kwangsoo; Kim, Sera

doi:10.1016/j.healthpol.2009.10.003

Cited by 15 publications

(31 citation statements)

References 27 publications

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“…Five included studies were conducted in the USA (USA 1993-2001; USA 1994-1998; USA 2002-2006; USA 2005-2014; USA 2006). The other four were from Germany, India, Kyrgyzstan and South Korea (Germany 2008; India 2001-2005; Kyrgyzstan 2001-2010; South Korea 2007).…”

Section: Resultsmentioning

confidence: 99%

“…The included studies considered the following types of interventions: dissemination of information (Germany 2008); improved detection and enforcement (South Korea 2007; USA 1994-1998); establishment of an independent agency and improved detection and enforcement (India 2001-2005; USA 1993-2001; USA 2005-2014); and increased transparency and accountability (Kyrgyzstan 2001-2010; USA 2002-2006; USA 2006). …”

Section: Resultsmentioning

confidence: 99%

“…The studies reported outcomes that included: physicians' attitudes (Germany 2008); number of complaints received and convictions (India 2001-2005); informal payments (Kyrgyzstan 2001-2010); overbilling (false or fraudulent claims) (South Korea 2007; USA 1993-2001); hospital utilisation, health outcomes and healthcare expenditures (USA 1994-1998); pharmaceutical company spending on gifts (USA 2002-2006); reports of fraud (USA 2006); money recovered from false or fraudulent claims, return on investment, new cases investigated, convictions, individuals and entities excluded from billing, and estimated programme savings (USA 2005-2014). …”

Section: Resultsmentioning

confidence: 99%

“…The other three studies lacked both a comparison group and data from before the intervention (India 2001-2005; USA 2002-2006; USA 2005-2014). …”

Section: Resultsmentioning

confidence: 99%

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Interventions to reduce corruption in the health sector

Gaitonde

Oxman

Okebukola

et al. 2016

Cochrane Database of Systematic Reviews

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Background Corruption is the abuse or complicity in abuse, of public or private position, power or authority to benefit oneself, a group, an organisation or others close to oneself; where the benefits may be financial, material or non-material. It is wide-spread in the health sector and represents a major problem. Objectives Our primary objective was to systematically summarise empirical evidence of the effects of strategies to reduce corruption in the health sector. Our secondary objective was to describe the range of strategies that have been tried and to guide future evaluations of promising strategies for which there is insufficient evidence. Search methods We searched 14 electronic databases up to January 2014, including: CENTRAL; MEDLINE; EMBASE; sociological, economic, political and other health databases; Human Resources Abstracts up to November 2010; Euroethics up to August 2015; and PubMed alerts from January 2014 to June 2016. We searched another 23 websites and online databases for grey literature up to August 2015, including the World Bank, the International Monetary Fund, the U4 Anti-Corruption Resource Centre, Transparency International, healthcare anti-fraud association websites and trial registries. We conducted citation searches in Science Citation Index and Google Scholar, and searched PubMed for related articles up to August 2015. We contacted corruption researchers in December 2015, and screened reference lists of articles up to May 2016. Selection criteria For the primary analysis, we included randomised trials, non-randomised trials, interrupted time series studies and controlled before-after studies that evaluated the effects of an intervention to reduce corruption in the health sector. For the secondary analysis, we included case studies that clearly described an intervention to reduce corruption in the health sector, addressed either our primary or secondary objective, and stated the methods that the study authors used to collect and analyse data. Data collection and analysis One review author extracted data from the included studies and a second review author checked the extracted data against the reports of the included studies. We undertook a structured synthesis of the findings. We constructed a results table and 'Summaries of findings' tables. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the certainty of the evidence. Main results No studies met the inclusion criteria of the primary analysis. We included nine studies that met the inclusion criteria for the secondary analysis. One study found that a package of interventions coordinated by the US Department of Health and Human Services and Department of Justice recovered a large amount of money and resulted in hundreds of new cases and convictions each year (high certainty of the evidence). Another study ...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…The other three studies lacked both a comparison group and data from before the intervention (India 2001-2005; USA 2002-2006; USA 2005-2014). …”

Section: Resultsmentioning

confidence: 99%

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Interventions to reduce corruption in the health sector

Gaitonde

Oxman

Okebukola

et al. 2016

Cochrane Database of Systematic Reviews

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“…One study found that the deterrent effect of government investigations of health claims for fraud and abuse significantly lowered the level of claims (Kang et al, 2010).…”

mentioning

confidence: 99%

Health-Care Reform in Korea

Jones

2010

OECD Economics Department Working Papers

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Medical professionals and health care fraud: Do they aid or check abuse?

Goel

2019

Manage Decis Econ

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This paper examines the role of health care professionals in combating health care fraud. It is not overall clear whether the share of the health professionals help control abuse. Using data across U.S. states, our econometric results show that greater employment of nurses consistently reduced health fraud, whereas more physicians did not have a significant impact. Further, more urbanized states and states with a greater proportion of the elderly experienced greater health scams. Identity thefts facilitated health care fraud, whereas different dimensions of health insurance (including the share of the population with Medicare, managed care, and no insurance) and hospital occupancy rates did not matter.

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The effects of the fraud and abuse enforcement program under the National Health Insurance program in Korea

Cited by 15 publications

References 27 publications

Interventions to reduce corruption in the health sector

Interventions to reduce corruption in the health sector

Health-Care Reform in Korea

Medical professionals and health care fraud: Do they aid or check abuse?

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