NCJ Number
110236
Date Published
1988
Length
23 pages
Annotation
Interviews with more than 50 enforcement officials sought to determine the nature and extent of abuse and fraud in the Medicaid program and issues and future directions for detection and enforcement efforts.
Abstract
Medicaid offers the opportunity to steal from an impersonal and faceless bureaucracy, and enforcement efforts are complicated by the fact that the program is federally authorized and subsidized but operated by the States. Exact statistics regarding the extent of Medicaid fraud do not exist, but commonly expressed views are that violations are the acts of a minority and that minor forms of fraud are extensive. The computerized record system's noting of blatantly aberrant practices and reporting by office staff or others of illegal practices are the main sources of detection of fraud and abuse. Prosecutors often do not proceed with cases, however, because they are complicated, often hinge on proof of intent, and are not as visible as violent crimes. Punishment, which generally consists of fines and the recovery of funds, is generally regarded by the behavioral science literature as an effective deterrent to white collar criminals. Proposed reforms include a movement from fee-for-service programs to health maintenance organizations and the use of a central clearinghouse to ensure that violators who move to other jurisdictions are brought to the attention of the authorities there. If enforcement efforts increase, it is unlikely that large numbers of physicians will withdraw from participation in Medicaid, however. However, the monitoring efforts have probably contributed to the unease physicians, still members of a profession enjoying high status, now express about their situation. 54 references.