ABSTRACT
Over the years, health care expenditures in the US have grown inexorably, raising concerns that costs are spiraling out of control. As the most expensive system globally, our government spends nearly double the amount for health care as other high-income nations such as England, Denmark, and Japan (Papanicolas, Woskie, & Jha, 2018). Compared to 1960 when approximately five percent of the nation’s gross domestic product (GDP) went toward national health care expenditures (Garner & McCabe, 2012), federal allocations for medical care currently constitute roughly one-fifth of the GDP (McPeak, 2018). With forecasts of continued increases in costs, our economy may not be able to withstand this escalating financial burden. Attesting to this, some experts warn of an impending Medicare program collapse that could jeopardize the health and lives of millions of Americans (Roy, 2011). In this regard, few challenges loom larger for policymakers and law enforcement. In the sections that follow, we take a closer look at fraud control efforts, as well as note some of the measures in place to address sexual misconduct. Moreover, we will highlight some of the challenges encountered in the pursuit of health care fraud convictions and the response to sexual misconduct complaints. We open with a discussion of advancements in health care law, which solely targets fraudulent behaviors. Attention is then given to government enforcement and regulatory actions taken against physician fraud and abuse/violence. We close by highlighting the legal complexities associated with these cases, including problems with establishing proof that a crime occurred and the role of victims in the criminal justice process.
