Health care fraud: a critical challenge

Manag Care Q. Winter 1996;4(1):67-79.


Fraud is defined as an international deception or misrepresentation that the individual or entity makes knowing that the misrepresentation could result in some unauthorized benefit to the individual, the entity, or some other party. This article focuses on acts committed by health care providers but it is important to note that health care fraud also encompasses those fraudulent acts perpetrated by employer groups, members or insureds, and employees.

MeSH terms

  • Capitation Fee
  • Employer Health Costs
  • Fee-for-Service Plans
  • Fraud / economics*
  • Fraud / legislation & jurisprudence
  • Fraud / statistics & numerical data
  • Health Care Costs / legislation & jurisprudence
  • Health Care Costs / statistics & numerical data*
  • Managed Care Programs / economics*
  • Managed Care Programs / legislation & jurisprudence
  • Managed Care Programs / organization & administration
  • Medical Records Systems, Computerized
  • Referral and Consultation / economics
  • United States