ABSTRACT

Beyond the prescription of unnecessary medical treatments (a point we return to in Chapter 3), theft and fraud, including underhanded billing and medical equipment schemes, represent the most pervasive and fastest growing white-collar crime trends in America’s $2.5 trillion health care system (Centers for Medicare and Medicaid Services, 2015). The sheer size of this industry, especially the medical insurance sector, makes it a lucrative target for fraud and abuse (Sparrow, 2008). Estimates indicate that around a tenth of US medical expenditures is wasted on fraud annually, amounting to upwards of $65 billion in losses per year (US Government Accountability Office, 2018; National Health Care Anti-Fraud Association, 2012). This chapter presents an overview of the breadth and nature of fraudulent behaviors committed by physicians, as well as applies contemporary criminological perspectives (i.e., routine activities theory and neutralization theory) to explain why physicians may engage in fraud.