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Article
Publication date: 23 June 2020

Nicole F. Stowell, Carl Pacini, Martina K. Schmidt and Nathan Wadlinger

This study aims to increase awareness and educate the reader about health-care fraud targeting seniors in the USA to help stakeholders better understand, recognize and prevent…

Abstract

Purpose

This study aims to increase awareness and educate the reader about health-care fraud targeting seniors in the USA to help stakeholders better understand, recognize and prevent this type of fraud.

Design/methodology/approach

This paper collects statistics on the current state of health care frauds committed against seniors, and examines related cases and laws.

Findings

The authors find this type of fraud is highly prevalent and expected to increase. Current laws preventing this fraud from occurring are multifold and complex. While prevention strategies through law enforcement have been somewhat successful, a reduction in resources may put seniors at an increased risk in the years to come.

Research limitations/implications

Without additional prevention strategies, the problem will likely escalate with a growing population of older adults. This study encourages further research into effective prevention strategies and methods to fight health-care fraud against seniors.

Practical implications

Health-care fraud and its associated costs pose a significant threat to the society and economy of the USA. Reducing this fraud will not only reduce the costs to the US economy but also improve the physical and mental well-being of senior victims, reduce their mortality and hospitalization rates and improve the public trust placed to health-care providers.

Originality/value

This study highlights how health-care fraud is committed against seniors. With the projected trend of an aging US population, educating stakeholders, increasing awareness and applying tools to protect seniors will be important to reduce the absolute scope of this problem in the future.

Article
Publication date: 1 October 2018

Nicole F. Stowell, Martina Schmidt and Nathan Wadlinger

The purpose of this paper is to make readers aware of the extensiveness of healthcare fraud in the USA and how it involves and affects the government, healthcare providers…

1818

Abstract

Purpose

The purpose of this paper is to make readers aware of the extensiveness of healthcare fraud in the USA and how it involves and affects the government, healthcare providers, insurance companies, patients and the public. In addition, recommendations are made that may help control this pervasive type of fraud.

Design/methodology/approach

A range of different journal publications, information from government health institutions and law enforcement websites, healthcare fraud cases and healthcare laws are used as a basis to provide information about how fraudsters are committing healthcare fraud and how to prevent this fraud from occurring.

Findings

Despite increased funding and prosecution efforts by the government, healthcare fraud continues to be a major threat to the US economy and public. While healthcare fraud will never be eradicated, specific efforts can be deployed to help rein in these complex fraud schemes.

Practical implications

The paper provides a useful resource of information on healthcare fraud for healthcare providers, insurance companies, patients and the public that may help combat healthcare fraud and prevent financial losses.

Social implications

Every dollar saved from combating fraud could be used to improve access to more or better health services and can, thereby, save lives.

Originality/value

This paper provides recommendations regarding healthcare fraud that could help prevent this large drain on the US economy.

Details

Journal of Financial Crime, vol. 25 no. 4
Type: Research Article
ISSN: 1359-0790

Keywords

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