ABSTRACT
This conclusion presents some closing thoughts on the concepts covered in the preceding chapters of this book. The book provides a better understanding of the complexity and seriousness of the fraud-control challenge and helps those within the industry see why and how existing control systems fail. Fraud in the health care system has been, and remains, out of control Electronic claims processing will make the situation much worse unless serious and urgent attention is paid to provision of prudent controls. If the health care industry were to learn the art of fraud control, they could cut costs quite substantially without denying the needy, restricting eligibility, or squeezing honest doctors out of business. Adequate investments in controls will never be made while the facts about the true nature and scope of health care fraud remain unknown. The health care fraud debate desperately needs the transforming effects of systematic measurement.
