Prevention and Control of Fraud - A Case Study of the Medicaid Program

• NCJ Number: 86513
• Author(s): J C Calpin; F C Jordan
• Date Published: 1981
• Length: 170 pages
• Grant Number(s): 80-BJ-CX-0017
• Sponsoring Agency: Bureau of Justice Statistics (BJS)
• Corporate Author: Mitre Corporation
• Sale Source: National Institute of Justice/
• Language: English
• Country: United States of America

Annotation

This report presents four case studies describing the efforts of the States of California, Michigan, Vermont, and Washington to control and prevent fraud in the Medicaid program.

Abstract

Each case study focuses on the information needed to detect accurately patterns of misuse of Medicaid funds by health care providers and to prosecute those cases where investigation establishes that a pattern of potentially fraudulent activity exists. These cases illustrate the prerequisites for developing proactive fraud prevention strategies that are designed to identify program weaknesses as well as detect fraudulent abuse. Charts and tables are given. References are provided with individual case studies.