Introduction to Fraud and Abuse Law

Abstract

This chapter focuses on healthcare fraud and the range of legal solutions provided to address fraud in the United States and Europe on a federal level. It provides key examples of the range of approaches to healthcare fraud that are adopted within Europe. It also analyzes the manner in which healthcare systems in the United States and Europe are funded and organized, considering that fraud is dynamic and dependent on the mechanisms for funding in the relevant system. This chapter reviews the issue of what qualifies as healthcare fraud, and it considers both the definitional problem and the interplay between the moral and ethical content of fraud and legal definitions of fraudulent conduct. It discusses operational issues in the identification, prevention, and punishment of healthcare fraud in the United States and Europe.