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Related Experiment Videos

"Sentinel effect" shows fraud control effort works.

D M Thornton1

  • 1Office of Inspector General, U.S. Department of Health and Human Services, USA.

Journal of Health Law
|February 8, 2000
PubMed
Summary
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This analysis reviews an agency's fraud and abuse enforcement, demonstrating its positive impact on healthcare and government finances. These efforts establish industry standards, countering claims of unfairness.

Area of Science:

  • Healthcare law and policy
  • Government enforcement and compliance

Background:

  • Analysis of historical fraud and abuse track record of a government agency.
  • Examination of the healthcare industry's response to enforcement actions.

Purpose of the Study:

  • To evaluate the beneficial results of agency enforcement efforts on the healthcare industry and federal fisc.
  • To dispute industry claims of unfair, arbitrary, or draconian enforcement tactics.

Main Methods:

  • Review of past agency enforcement actions and their outcomes.
  • Analysis of industry responses and adherence to established standards.

Main Results:

  • Enforcement actions have yielded direct and indirect benefits for the healthcare sector and government finances.

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  • Industry standards have been positively influenced by documented enforcement precedents.

    • Conclusions:

    • The agency's enforcement efforts are a justified and appropriate response to documented healthcare fraud and abuse.
    • The enforcement track record demonstrates a net positive effect, contrary to criticisms of being unfair or arbitrary.