In the past 40 years, the health of citizens in the United States has changed significantly. The population of the United States managed to get sicker and die slower across the prior four decades. Adding to this complexity is the fact that illnesses and health behaviors in the United States are also not equally distributed by race, class, gender, or other social factors. These facts do not only reflect level of the disease and illness in the United States, but also the disparities that exist within them and the sociomedical factors that impact health. Despite costing American taxpayers between $120 billion to $1.32 trillion a year, one sociomedical factor not addressed in the literature is the impact of healthcare fraud on health. Data for US counties and county-equivalents were used to create a custom dataset of secondary data that was used in heat maps, bivariate correlations, and logistic regressions to examine the relationships between social disorganization, urbanization, healthcare fraud, and community health. This study sought to test whether: (1) social disorganization increases healthcare fraud, (2) healthcare fraud decreases community health outcomes, and lastly, (3) Medicare and Medicaid expenditures mediate the effect of healthcare fraud on community health. Results from this analysis showed that counties with high social disorganization are 1.63 times more likely (log odds: 1.6300, p < .05) to have high healthcare fraud rates than counties with low social disorganization when controlling for health insurance and education. The data also showed that healthcare fraud is not a significant predictor (p >.05) of community health when controlling for health insurance and education. Additionally, the results showed that Medicare and Medicaid expenditures did not significantly (p > .05) mediate the effect of social disorganization on healthcare fraud, or of healthcare fraud on community health outcomes. However, the biggest finding of this study was that the size, complexity, invisibility, and trusted nature of the public health insurance system in the United States make it "easy money" for perpetrators.
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Doctor of Philosophy (Ph.D.)
College of Sciences
Length of Campus-only Access
Doctoral Dissertation (Open Access)
Alvarez Irizarry, Wilmer, "Easy Money: Examining Social Disorganization, Urbanization, Healthcare Fraud, and Community Health in America." (2021). Electronic Theses and Dissertations, 2020-. 466.