License To Steal: How Fraud bleeds America's Health Care System

* Preface * Acknowledgments * Introduction * Fictitious Companies Part 1 * The State of the Art * Control Failures * Two Distinct Sciences: Fraud Detection, and Utilization Review, How Goes the War? * Counterattack, Part 2 * New Frontiers for Control * False Claims * Managed Care Part 3 * The Nature of the Fraud-Control Challenge * The Pathology of Fraud Control * The Importance of Measurement * Assessment of Existing Fraud-Control Systems * The Antithesis of Modern Claims Processing Part 4 * Prescription for Progress * A Model Fraud-Control Strategy * Detection Systems * Conclusion * Acronyms and Abbreviations * Notes * Index