ABSTRACT
At the time of this writing in early 2010, the U.S. Congress passed sweeping legislation that was designed to signi¤cantly overhaul the present healthcare system. Although implementation of this hard-won reform will not come easily or quickly, the process has refocused attention on a problem that has plagued healthcare for decades-fraud. Fraud is frequently de¤ned as deceit or breach of con¤dence perpetrated for pro¤t or to gain some unfair or dishonest advantage; Fabrikant et al. (2006) said it traditionally involves “a knowing misrepresentation or omission of fact,” and added that healthcare fraud cases “o›en involve complex issues of law and regulatory interpretation, ¤nancial and economic policy, and medical and clinical decision-making.” For the purposes of this work, fraud applies to ¤nancial the› and scheming as well as medical identity the›.
