Title

Nursing Home Research In Jinan, China: A Focus Group Approach

Keywords

Abuse algorithms; Consumer awareness; Healthcare fraud; Medical care fraud; White-collar crime

Abstract

Healthcare fraud and abuse by medical providers is a form of white-collar crime that has had considerable cost and consequences to society. The following study seeks to investigate factors associated with consumers that make them susceptible to potential fraud and abuse schemes. The analysis consists of 56,441 health consumers identified through Blue Cross and Blue Shield Association (BCBSA) fraud algorithms for high cost patients, billing after hour procedures and using modifiers in claims payments. The logistic regression results for any fraud event show that those who reside in the south region of Florida [odds ratio (OR) 2.39, (2.33-2.44)], are Caucasian [OR 2.07, (2.02-2.11)], with a preference sensitive condition (like hip, knee or back problems) [OR 1.76, (1.73-1.80)], who speak English [OR 1.47, (1.45-1.50)], with a higher average future risk score [OR 1.29, (1.28-1.30)], are female [OR 1.16, (1.14-1.18)] and have HMO insurance [OR 1.14, (1.11-1.18)] were more likely to have encountered potential fraud during 2008. © 2012 Inderscience Enterprises Ltd.

Publication Date

3-1-2012

Publication Title

International Journal of Public Policy

Volume

8

Issue

1-3

Number of Pages

21-30

Document Type

Article

Personal Identifier

scopus

DOI Link

https://doi.org/10.1504/IJPP.2012.045869

Socpus ID

84863368943 (Scopus)

Source API URL

https://api.elsevier.com/content/abstract/scopus_id/84863368943

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