ABSTRACT
The United States spends more than $1 trillion on health care each year; roughly 15 percent of the gross national product. According to investigators specializing in durable medical equipment suppliers fraud, Certificates of Medical Necessities provide little protection. Investigators in major US cities describe “whole communities living off Medicaid fraud.” The Federal Bureau of Investigation has intelligence showing cocaine traffickers in Florida and California switching from drug-dealing to health care fraud. While the nation struggles to restrain spending on health care and deliberates over reform, a colossal amount of time and energy is being devoted to debate about fraud and abuse. Officials plead for more resources and more effective tools, pressing for fraud-control legislation that would grant more effective prosecutorial and exclusionary powers. Most competent fraud perpetrators study the rule book carefully—probably more carefully than most honest providers—because they want to avoid scrutiny at any cost. The chapter also presents an overview of the key concepts discussed in this book.
