NCJ Number
169214
Journal
Social Justice Volume: 22 Issue: 2 Dated: (Summer 1995) Pages: 125-138
Date Published
1995
Length
14 pages
Annotation
This article focuses on fraud and waste as they have occurred in the past in the delivery of medical services and, most particularly, as they will occur in the quickly expanding health- care reforms that embrace managed care.
Abstract
President Clinton's attempt to inaugurate a comprehensive health-care program based on a system of managed care ended in failure. That failure, however does not mark the end of such efforts. A conservative Congress already is bringing once- sacrosanct medical programs such as Medicare under its scrutiny in an attempt to control costs. For the same reason, the practice of medicine increasingly is coming under the control of corporate organizations. Current fee-for-service arrangements have been plagued by fraud and abuse. Investigators who work in the field are convinced that physicians and other practitioners bilk the programs to an unconscionable degree, and only the most egregious and stupid are ever apprehended. The health-care programs that sooner or later will emerge will also be vulnerable to serious forms of fraud. Although little planning has focused on the protection of the public against fraud and abuse under the emergent health-care systems, the fact that medical care will, in many cases, be placed into corporate hands offers some promise that criminal laws will be more effective in targeting and prosecuting medical fraud. Because the power of corporations has been deemed to be excessively threatening if not circumscribed, courts have allowed the imposition of strict liability on corporate entities; that is, corporations cannot avoid liability by the use of an affirmative defense such as a claim of due diligence, good faith, or the absence of any inflicted loss, even if these were to be provable. Under the new Federal sentencing guidelines, corporations convicted of criminal wrongdoing can be targeted not only for tougher penalties, but also for a much wider range of other sanctions than ever before. 38 references