ABSTRACT
Health care fraud advisories continually remind patients to check their explanations of medical benefits (EOMB) carefully. EOMBs have not been used in connection with home health care services—one of the most fraud prone categories of service—since 1981. The non-self-revealing nature of nearly all health care fraud schemes exacerbates the difficulty of seeing the fraud problem clearly. Society places enormous trust in health care professionals, and rightly so. Their resulting defensiveness, however, has historically inclined the profession and its associations to play down the extent and seriousness of health care fraud and to oppose provision of additional resources for the purpose of investigation and review. Investigators believe health care insurers and payers are naive to assume, as they do with physicians, that for the provider groups the drive for self-enrichment would be subordinated to higher professional obligations. Investigators report that they are beginning to see corporate fraud being committed within the health care industry at an unprecedented level.
