Table of Contents

* 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

About the Author

Malcolm K. Sparrow teaches Regulatory and Enforcement Strategy, and Analytic Methods, at Harvard's John F. Kennedy School of Government. Formerly a Detective Chief Inspector with the British police service, he now specializes in issues of enforcement strategy, regulatory compliance, and risk control- he is the acknowledged national expert on the subject of Health Care Fraud. He is author of The Risk Business: Defining the Regulatory Craft (2000), License to Steal: Why Fraud Plagues America's Health Care System (1996), Imposing Duties: Government's Changing Approach to Compliance (1994) and co-author of Beyond 911: A New Era for Policing (1990) and Ethics in Government: The Moral Challenge for Public Leadership (1990).