Fraud in Universal Coverage: The Usual Suspects (and then Some)

Abstract

This Article addresses the often overlooked potential for health care fraud in health care reform efforts, focusing on the recent Massachusetts example. My premise is that any reform effort that increases the opportunities to commit fraud, such as by increasing the number of players in the health care system and the obligations imposed on them, may well end up losing more money to fraudulent activities. To the extent that a market-based approach, combined with moderate expansions in publicly funded health care programs, proves to be the only politically feasible strategy for health care reform at this time, it is likely that both the motivations and the opportunities for people to engage in fraudulent and abusive activities will increase. Experience has shown us that it is far better to plan for these contingencies in advance than to assume, rather naively, that health care reform will mitigate the temptation to take advantage of the system.