Review by Choice Review
A serious (despite the catchy title), excellently researched examination of the possible extent of fraud in the US health care system. Sparrow argues that scant literature exists because the providers and insurers really do not want to know and have no incentive to find out the true extent of fraud, perhaps because they are not coping with fraud already being committed. Fraud in the health care system, he concluded, has been and remains out of control. Eight sites were studied using 15 question areas over a period of two to three years. Sparrow makes no attempt to estimate the dollar costs of fraud or the actual extent of fraud in quantitative terms; rather, he documents the ongoing nature of fraud and suggests components of any model fraud-control strategy: (1) commitment to routine, systematic measurement; (2) resource allocation for controls based on an assessment of the seriousness of the problem; (3) clear designation of responsibility for fraud control; (4) adoption of a problem-solving approach; (5) deliberate focus on early detection of new types of fraud; (6) prepayment, fraud-specific controls; and (7) every claim faces some risk of review. This writing will probably stand as an authoritative study of the subject on criminal fraud control in the health care system for the next few years. All levels. J. E. Allen; University of North Carolina at Chapel Hill
Copyright American Library Association, used with permission.
Review by Booklist Review
One of the sidelights to the debate over health-care reform is the media attention, often sensational, devoted to fraud. Sparrow, a public-policy lecturer at Harvard's Kennedy School of Government and coauthor of a book about community policing entitled Beyond 911 (1990), contends that fraud in our health-care system is rampant. Despite his tabloidlike title, Sparrow takes a serious, often technocratic look at the industry's efforts at fraud control--and the lack thereof. He focuses on provider fraud as opposed to patient fraud, arguing that the former outpaces the latter by exponential proportions. He shows that most safeguards are designed to detect the abuse of overbilling rather than criminal fraud by those who "correctly" bill for procedures not even performed on patients who may not even exist. Sparrow also warns that electronic claims processing will worsen the problem because it will enable fraud to be committed faster, long before it can be detected. License to Steal adds an important dimension to the issue of health-care reform. --David Rouse
From Booklist, Copyright (c) American Library Association. Used with permission.
Review by Choice Review
Review by Booklist Review
