메뉴 건너뛰기




Volumn 7, Issue 8, 2012, Pages

No evidence of the effect of the interventions to combat health care fraud and abuse: A systematic review of literature

Author keywords

[No Author keywords available]

Indexed keywords

ABUSE; ARTICLE; CLASSIFICATION; CLINICAL EFFECTIVENESS; COST EFFECTIVENESS ANALYSIS; DATA BASE; DETECTION CATEGORY; FRAUD; HEALTH CARE; HEALTH CARE CONCEPTS; INTERVENTION STUDY; PREVENTION CATEGORY; RESPOSNE CATEGORY; REVIEW; SENSITIVITY ANALYSIS; SYSTEMATIC REVIEW; TAIWAN; UNITED STATES;

EID: 84865289842     PISSN: None     EISSN: 19326203     Source Type: Journal    
DOI: 10.1371/journal.pone.0041988     Document Type: Review
Times cited : (41)

References (45)
  • 1
    • 84876668609 scopus 로고    scopus 로고
    • NHCAA (US), US: National Health Cara Anti-Fraud Association. Consumer Info & Action. Available, Accessed 2009 October 10
    • NHCAA (US). A Private-Public Partnership Against Health Care Fraud [Internet]. US: National Health Cara Anti-Fraud Association. Consumer Info & Action. Available: http://www.nhcaa.org/eweb/DynamicPage.aspx?webcode=anti_fraud_resource_centr&wpscode=ConsumerAndActionInfo. Accessed 2009 October 10.
    • (2009) A Private-Public Partnership Against Health Care Fraud [Internet]
  • 2
    • 0030330716 scopus 로고    scopus 로고
    • Health Care Fraud Control Understanding The Challenge
    • Sparrow MK, (1996) Health Care Fraud Control Understanding The Challenge. J Insur Med 28: 86-96.
    • (1996) J Insur Med , vol.28 , pp. 86-96
    • Sparrow, M.K.1
  • 3
    • 84856427815 scopus 로고    scopus 로고
    • NHCAA (US). A Private-Public Partnership Against Health Care Fraud [Internet]. US:National Health Cara Anti-Fraud Association, Available, Accessed 2009 October 10
    • NHCAA (US). A Private-Public Partnership Against Health Care Fraud [Internet]. US: National Health Cara Anti-Fraud Association. The Problem of Health Care Fraud. Available: http://www.nhcaa.org/eweb/DynamicPage.aspx?webcode=anti_fraud_resource_centr&wpscode=TheProblemOfHCFraud. Accessed 2009 October 10.
    • The Problem of Health Care Fraud
  • 4
    • 84876666372 scopus 로고    scopus 로고
    • Gee J, Button M, Brooks G, Vincke P. The financial cost of healthcare fraud [Internet]. Portsmouth: University of Portsmouth, MacIntyre Hudson, Milton Keynes. Available: http://eprints.port.ac.uk/3987/1/The-Financial-Cost-of-Healthcare-Fraud-Final-(2).pdf. Accessed 2010 December 20.
  • 9
    • 85045353143 scopus 로고    scopus 로고
    • Corruption in health care systems: the US experience
    • Kotalik J, Rodriguez D, editors. Global Corruption Report 2006. London: Pluto Press
    • Sparrow MK (2006) Corruption in health care systems: the US experience. In: Transparency International, Kotalik J, Rodriguez D, editors. Global Corruption Report 2006. London: Pluto Press. pp.16-22.
    • (2006) Transparency International , pp. 16-22
    • Sparrow, M.K.1
  • 10
    • 49549089070 scopus 로고    scopus 로고
    • A survey on statistical methods for health care fraud detection
    • Li J, Huang KY, Jin J, Shi J, (2008) A survey on statistical methods for health care fraud detection. Healthc Manag Sci 11: 275-87.
    • (2008) Healthc Manag Sci , vol.11 , pp. 275-287
    • Li, J.1    Huang, K.Y.2    Jin, J.3    Shi, J.4
  • 11
    • 0033615315 scopus 로고    scopus 로고
    • Health care fraud and abuse
    • Kalb PE, (1999) Health care fraud and abuse. JAMA 22: 1163-8.
    • (1999) JAMA , vol.22 , pp. 1163-1168
    • Kalb, P.E.1
  • 12
    • 84993044910 scopus 로고    scopus 로고
    • Categories of financial crime
    • Gottschalk P, (2010) Categories of financial crime. J Financ Crim 17: 441-58.
    • (2010) J Financ Crim , vol.17 , pp. 441-458
    • Gottschalk, P.1
  • 13
    • 39749121452 scopus 로고    scopus 로고
    • Review of corruption in the health sector: theory, methods and interventions
    • Vian T, (2008) Review of corruption in the health sector: theory, methods and interventions. Health Polic Plann 23: 83-94.
    • (2008) Health Polic Plann , vol.23 , pp. 83-94
    • Vian, T.1
  • 14
    • 84876685463 scopus 로고    scopus 로고
    • KPMG International. Fraud Risk Management. Available: http://www.kpmg.com/CN/en/IssuesAndInsights/ArticlesPublications/documents/Fraud-Risk-Management-O-200610.pdf. Accessed 2011 April 10.
  • 15
    • 84876688098 scopus 로고    scopus 로고
    • EPOC (Can). EMBASEstudyfilterEPOC.doc [Internet]. Can: Cochrane Effective Practice and Organisation of Care Group. Available: http://epoc.cochrane.org/sites/epoc.cochrane.org/files/uploads/EMBASEstudyfilterEPOC.doc. Accessed 2012 January 16.
  • 16
    • 18244389950 scopus 로고    scopus 로고
    • A review and analysis of the clinical laboratory improvement amendment of 1988: compliance plans and enforcement policy
    • Rivers PA, Dobalian A, Germinario FA, (2005) A review and analysis of the clinical laboratory improvement amendment of 1988: compliance plans and enforcement policy. Health Care Manag Rev 30: 93-102.
    • (2005) Health Care Manag Rev , vol.30 , pp. 93-102
    • Rivers, P.A.1    Dobalian, A.2    Germinario, F.A.3
  • 17
    • 1842485999 scopus 로고    scopus 로고
    • Insurance fraud: issues and challenges
    • Available from, Accessed 2010 December 20
    • Viaene S, Dedene G (2004) Insurance fraud: issues and challenges. Geneva Papers Risk Insurance [Internet]. Available from: http://www.genevaassociation.org/PDF/Geneva-papers_on_Risk_and_Insurance/GA2004_GP29(2)_Viaene&Dedene.pdf. Accessed 2010 December 20.
    • (2004) Geneva Papers Risk Insurance [Internet]
    • Viaene, S.1    Dedene, G.2
  • 18
    • 84876664871 scopus 로고    scopus 로고
    • HCAA (US). Health Care Compliance Association [Internet]. Corporate Compliance for the Health Care Professional. Available: http://hcca-info.org/Content/NavigationMenu/ComplianceResources/ComplianceBasics/default.htm. Accessed 2012 April 10.
  • 19
    • 0032601897 scopus 로고    scopus 로고
    • Corporate compliance: framework and implementation
    • Fowler N, (1999) Corporate compliance: framework and implementation. Radiol Manag 21: 50-3.
    • (1999) Radiol Manag , vol.21 , pp. 50-53
    • Fowler, N.1
  • 20
    • 84865287545 scopus 로고    scopus 로고
    • Assessing issues and problems in relationship between basic insurance organizations and university hospitals: a qualitative research
    • Nasirirad N, Rashidian R, Joudaki H, Akbari Haghighi F, Arab M, (2010) Assessing issues and problems in relationship between basic insurance organizations and university hospitals: a qualitative research. Hospital 9: 7-19 [In Persian].
    • (2010) Hospital , vol.9 , pp. 7-19
    • Nasirirad, N.1    Rashidian, R.2    Joudaki, H.3    Akbari Haghighi, F.4    Arab, M.5
  • 21
    • 79957617103 scopus 로고    scopus 로고
    • A medical claim fraud/abuse detection system based on data mining: a case study in Chile
    • In: Crone SF, Lessmann S, Stahlbock R, editors, The 2006 World Computer Engineering, and Applied Computing. Las Vegas: CSREA Press
    • Ortega PA, Figueroa CJ, Ruz GA (2006) A medical claim fraud/abuse detection system based on data mining: a case study in Chile. In: Crone SF, Lessmann S, Stahlbock R, editors. Proceedings of the 2006 International Conference on Data Mining. The 2006 World Computer Engineering, and Applied Computing. Las Vegas: CSREA Press. pp 224-231.
    • (2006) Proceedings of the 2006 International Conference on Data Mining , pp. 224-231
    • Ortega, P.A.1    Figueroa, C.J.2    Ruz, G.A.3
  • 22
    • 84865285958 scopus 로고    scopus 로고
    • Assessing medical misconduct and complaints in Iran health system: a systematic review of literature
    • Rashidian A, Joudaki H, (2010) Assessing medical misconduct and complaints in Iran health system: a systematic review of literature. Sci J Forensic Med 15: 234-43 [In Persian].
    • (2010) Sci J Forensic Med , vol.15 , pp. 234-243
    • Rashidian, A.1    Joudaki, H.2
  • 23
    • 0042421807 scopus 로고    scopus 로고
    • Statistical fraud detection: A review
    • Bolton RJ, Hand DJ, (2002) Statistical fraud detection: A review. Stat Sci 17: 235-49.
    • (2002) Stat Sci , vol.17 , pp. 235-249
    • Bolton, R.J.1    Hand, D.J.2
  • 24
    • 66049083627 scopus 로고    scopus 로고
    • A Taxonomy of Frauds and Fraud Detection Techniques
    • Laleh N, Abdollahi Azgomi M, (2009) A Taxonomy of Frauds and Fraud Detection Techniques. Inf Syst Technol Manag DOI: 10.1007/978-3-642-00405-6_28.
    • (2009) Inf Syst Technol Manag
    • Laleh, N.1    Abdollahi Azgomi, M.2
  • 25
    • 84876693529 scopus 로고    scopus 로고
    • Phua C, Lee V, Smith K, Gayler R. A comprehensive survey of data mining-based fraud detection research [Internet]. Melbourne: Monash University. Available from: http://arxiv.org/abs/1009.6119. Accessed 2010 December 20.
  • 26
    • 84865286747 scopus 로고    scopus 로고
    • Review of relevant legislation about physician's misconduct in Iran
    • Joudaki H, Rashidian A, Milanifar AR, (2010) Review of relevant legislation about physician's misconduct in Iran. Sci J Forensic Med 16: 215-23 [in Persian].
    • (2010) Sci J Forensic Med , vol.16 , pp. 215-223
    • Joudaki, H.1    Rashidian, A.2    Milanifar, A.R.3
  • 27
  • 28
    • 84876670282 scopus 로고    scopus 로고
    • Popay J, Roberts H, Sowden A, Petticrew M, Arai L, et al. (2006) Guidance on the conduct of narrative synthesis in systematic reviews: A product from the ESRC Methods Programme [Internet]. Lancaster: Institute of Health Research. Available: http://www.lancs.ac.uk/shm/research/nssr/research/dissemination/publication.php/. Accessed 2010 December.
  • 29
    • 58149196988 scopus 로고    scopus 로고
    • Detecting hospital fraud and claim abuse through diabetic outpatient services
    • Liou FM, Tang YC, Chen JY, (2008) Detecting hospital fraud and claim abuse through diabetic outpatient services. Health Care Manag Sci 1: 353-8.
    • (2008) Health Care Manag Sci , vol.1 , pp. 353-358
    • Liou, F.M.1    Tang, Y.C.2    Chen, J.Y.3
  • 30
    • 33644780888 scopus 로고    scopus 로고
    • A process-mining framework for the detection of healthcare fraud and abuse
    • Yang WS, Hwang SY, (2006) A process-mining framework for the detection of healthcare fraud and abuse. Expert Syst Appl 31: 56-68.
    • (2006) Expert Syst Appl , vol.31 , pp. 56-68
    • Yang, W.S.1    Hwang, S.Y.2
  • 32
    • 0024602772 scopus 로고
    • Physicians' attitudes toward using deception to resolve difficult ethical problems
    • Novack DH, Detering BJ, Arnold R, Forrow L, Ladinsky M, et al. (1989) Physicians' attitudes toward using deception to resolve difficult ethical problems. JAMA 261: 2980-2985.
    • (1989) JAMA , vol.261 , pp. 2980-2985
    • Novack, D.H.1    Detering, B.J.2    Arnold, R.3    Forrow, L.4    Ladinsky, M.5
  • 33
    • 28244478062 scopus 로고    scopus 로고
    • Lying to insurance companies: The desire to deceive among physicians and the public
    • Werner R, Alexander G, Fagerlin A, Ubel P, (2004) Lying to insurance companies: The desire to deceive among physicians and the public. Am J Bioeth 4: 53-9.
    • (2004) Am J Bioeth , vol.4 , pp. 53-59
    • Werner, R.1    Alexander, G.2    Fagerlin, A.3    Ubel, P.4
  • 34
    • 0037182039 scopus 로고    scopus 로고
    • The "Hassle Factor": What Motivates Physicians to Manipulate Reimbursement Rules?
    • Werner RM, Alexander GC, Fagerlin A, Ubel PA, (2002) The "Hassle Factor": What Motivates Physicians to Manipulate Reimbursement Rules? Arch Intern Med 162: 1134-1139.
    • (2002) Arch Intern Med , vol.162 , pp. 1134-1139
    • Werner, R.M.1    Alexander, G.C.2    Fagerlin, A.3    Ubel, P.A.4
  • 35
    • 0034639924 scopus 로고    scopus 로고
    • Physician manipulation of reimbursement rules for patients
    • Wynia MK, Cummins DS, VanGeest JB, Wilson IB, (2000) Physician manipulation of reimbursement rules for patients. JAMA 283: 1858-1865.
    • (2000) JAMA , vol.283 , pp. 1858-1865
    • Wynia, M.K.1    Cummins, D.S.2    VanGeest, J.B.3    Wilson, I.B.4
  • 36
    • 0037453120 scopus 로고    scopus 로고
    • Support for physician deception of insurance companies among a sample of Philadelphia residents
    • Alexander GC, Werner RM, Fagerlin A, Ubel PA, (2003) Support for physician deception of insurance companies among a sample of Philadelphia residents. Ann Intern Med 138: 472-475.
    • (2003) Ann Intern Med , vol.138 , pp. 472-475
    • Alexander, G.C.1    Werner, R.M.2    Fagerlin, A.3    Ubel, P.A.4
  • 37
    • 28244478062 scopus 로고    scopus 로고
    • Lying to insurance companies: the desire to deceive among physicians and the public
    • Werner RM, Alexander GC, Fagerlin A, Ubel PA, (2004) Lying to insurance companies: the desire to deceive among physicians and the public. Am J Bioeth 4: 53-9.
    • (2004) Am J Bioeth , vol.4 , pp. 53-59
    • Werner, R.M.1    Alexander, G.C.2    Fagerlin, A.3    Ubel, P.A.4
  • 39
    • 0034975563 scopus 로고    scopus 로고
    • Precursory steps to mining HCFA health care claims
    • Hawaii: IEEE Conference Publications. Available, Accessed 2009 October 10.
    • Sokol L, Garcia B, West M, Rodriguez J, Johnson K (2001) Precursory steps to mining HCFA health care claims. In: Proceedings of the 34th Hawaii International Conference on System Sciences [Internet.].Hawaii: IEEE Conference Publications. Available: http://ieeexplore.ieee.org/search/searchresult.jsp?queryText%3Dsokol&refinements=4294175854&pageNumber=1&resultAction=REFINE.DOI: 10.1109/HICSS.2001.926570. Accessed 2009 October 10.
    • (2001) Proceedings of the 34th Hawaii International Conference on System Sciences [Internet.]
    • Sokol, L.1    Garcia, B.2    West, M.3    Rodriguez, J.4    Johnson, K.5
  • 40
    • 84876672726 scopus 로고    scopus 로고
    • NHS Counter Fraud and Security Management Service (GB) (2006) The international fraud and corruption report; A study of selected countries [Internet]. UK: NHS Counter Fraud and Security Management Service. Available: http://www.nhsbsa.nhs.uk/CounterFraud/Documents/International_fraud_and_corruption_report.pdf. Accessed 2010 November.
  • 41
    • 84876673813 scopus 로고    scopus 로고
    • Transparency International, Kotalik J, Rodriguez D, editors (2006) Global Corruption Report 2006 [Internet]. London: Pluto Press. Available: http://www.transparency.org/publications/gcr/gcr_2006#download. Accessed 25 January 2012.
  • 42
    • 84876694697 scopus 로고    scopus 로고
    • NHS Counter Fraud and Security Management Service (GB) (2008) NHS Fraud Risk Measurement Exercises; Identifying the nature and scale of the problem [Internet]. UK: NHS Counter Fraud and Security Management Service. Available from: http://www.nhsbsa.nhs.uk/i/CounterFraud/Identifying.the.nature.and.scale.of.the.problem.pdf. Accessed 2010 November.
  • 43
    • 34249026924 scopus 로고    scopus 로고
    • Monitoring Corruption: Evidence from a Field Experiment in Indonesia
    • Olken BA, (2007) Monitoring Corruption: Evidence from a Field Experiment in Indonesia. J Politic Econ 115: 200-249.
    • (2007) J Politic Econ , vol.115 , pp. 200-249
    • Olken, B.A.1
  • 44
    • 36649032504 scopus 로고    scopus 로고
    • Situational deterrence and claim padding: results from a randomized field experiment
    • Blais E, Bacher JL, (2007) Situational deterrence and claim padding: results from a randomized field experiment. J Exp Criminol 3: 337-52.
    • (2007) J Exp Criminol , vol.3 , pp. 337-352
    • Blais, E.1    Bacher, J.L.2
  • 45
    • 0029688337 scopus 로고    scopus 로고
    • Nurses and other experts views of health care fraud and abuse
    • Ahern MM, (1996) Nurses and other experts views of health care fraud and abuse. Nurs Econ 14: 40-8.
    • (1996) Nurs Econ , vol.14 , pp. 40-48
    • Ahern, M.M.1


* 이 정보는 Elsevier사의 SCOPUS DB에서 KISTI가 분석하여 추출한 것입니다.