Case Study

Tackling healthcare fraud

4 pages
December 2004
Reference: IMD-3-1463

Aiming to contain vast and fast-rising expenditure levels estimated to amount to 8.2% of GDP across OECD countries in 2003, national healthcare reforms cannot avoid rationing, that is withholding beneficial interventions from needy individuals. Yet, a substantial part of a nation’s healthcare spending is typically diverted in illicit ways–rendering otherwise feasible care unattainable and undermining the legitimacy of private and public services. In the US healthcare fraud and abuse reportedly accounts for around 10% of total outlays, i.e., $120 billion per year. In the UK prescription crime in 2003 was estimated to amount to £115 million. In Lower Saxony, one of Germany’s 16 Länder, insurance fraud alone accounted for €40 million in 2003. But cases are not always clear-cut and not always easily dealt with. There is often substantial ambiguity in defining what is actually improper conduct, identifying such behavior among vast numbers of cases that are handled annually, telling errors apart from criminal intent, and choosing adequate regulatory responses. This case can be used in conjunction with IMD-3-1464, IMD-3-1465, and IMD-3-1466.

Corruption, Fraud, Regulation
Published Sources
© 2004
Available Languages
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