Research in the medical literature suggests that the investigation of fraud in the home health care field grew significantly throughout the 1990s. Although criminologists have examined health care fraud by physicians, virtually no criminological research has assessed crime within the home hath care industry. This article attempts to fill that void by considering the kinds of home health care offenses that are investigated by fraud control units throughout the United States. Content analysis is performed on 247 reported incidents of home health cue abuses. Finding indicate that home health care professionals commit offenses that are similar to, yet different from, those that are committed by doctors. The importance of community service as a sanction for these offenders, and the need for background checks, are considered. Support for conflict theory and general systems theory emerges as well.
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References
1.
Bellandi, D.
, & Hallam, K. (1998). G-men: Federal resources are stacking up to tackle health care fraud. Modern Health Care, 28(10), 32-36.
2.
Bender, J. P.
(2000). Medical home health care plunges. Florida Business Journal, 20(41), 1-5.
3.
Benson, M.
(1985). Denying the guilty mind. Criminology, 23, 589-599.
4.
Berg, B. L.
(2001). Qualitative research methods for the social sciences. Boston: Allyn and Bacon.
5.
Blickenstaf, K.
(1999). DOJ and states keep escalating fraud enforcement. National Law Journal, 23(3), B14.
6.
Braswell, M.
, & Whitehead, J. (1999). Seeking the truth: An alternative to conservative and liberal thinking in criminology. Criminal Justice Review, 24, 50-63.
7.
Braus, P.
(1994). When Mom needs help. American Demographics, 16(3), 38-46.
8.
Breen, C. C.
(1999, June 23). Doctor arraigned after fleeing fraud probe. Associated Press Newswires, n.p.
9.
Bureau of Labor Statistics, United States Department of Labor
. (1997). Injuries to caregivers working in patients' homes. Washington, DC: United States Government Printing Office.
10.
Bureau of Labor Statistics, United States Department of Labor
. (2000). Occupational outlook handbook, 2000-2001 edition. Washington, DC: United States Government Printing Office.
11.
Byars, K.
, & Payne, B. K. (2000). Medical students' and physicians' attitudes about Medicaid fraud. Journal of Health and Human Services Administration, 23(2), 60-82.
12.
Caputo, G. A.
(1999). Why not community service?Criminal Justice Policy Review, 10, 503-519.
13.
Chesney-Lind, M.
(1978). Chivalry re-examined: Women and the criminal justice system. In L. Bowker (Ed.), Women, crime, and the criminal justice system (pp. 171-196). Lexington, MA: Lexington Books.
14.
Deparle, M. M.
(2000). Celebrating 35 years of Medicare and Medicaid. Health Care Financing Review, 22, 1-7.
15.
Dodd, K.
(1999). Home health care provides healing for patients, hospitals. Kansas City Business Journal, 18(9), 22.
16.
Dudek, E.
(1998). Medicaid fraud and abuse in Florida. Florida Bar Journal, 72(4), 4447.
17.
Few, A.
, & Trezevant, J. G. (1998). Fighting the battle against health care fraud. Florida Bar Journal, 72(4), 33-43.
18.
Forero, J.
(1997). Background checks for health aides after serious death. Star Ledger Newark, p. 018.
19.
Freedman, E.
(1996). Operation Restore Trust nabs physicians for fraud. American Medical News, 39(23), 6-10.
20.
Gallo, J. N.
(1998). Effective law enforcement techniques for reducing crime. Journal of Criminal Law and Criminology, 88, 1475-1500.
21.
Geis, G.
, Jesilow, P., Pontell, H. N., & O'Brien, M. (1985). Fraud and abuse of government medical benefit programs by psychiatrists. American Journal of Psychiatry, 142, 231-234.
22.
Goldberg, C.
(1997). Fraud and abuse on the rise. LI Business News, 25, 1-2.
23.
Harbist, N. C.
(2001). The attack on health care fraud gathers broad political support. New Jersey Law Journal, 163(7), 28-35.
24.
Harshbarger, H.
(1993). Fraud detection and prosecution. Boston: Office of the Attorney General.
25.
Havemann, J.
(1997, July 24). Fraud is rife with home care for the elderly. Washington Post, p. A1.
26.
Hodge, P. D.
(1998). National law enforcement programs to detect, investigate, and prosecute elder abuse and neglect in health care facilities. Journal of Elder Abuse & Neglect, 9(4), 23-41.
27.
Hoffman, E. D.
, Klees, B: S., & Curtis, C. A. (2000). Overview of the Medicare and Medicaid programs. Health Care Financing Review, 22, 171-193.
28.
Jesilow, P.
, Geis, G., & Harris, J. C. (1995). Doomed to repeat our errors. Social Justice, 22, 125-138.
29.
Jesilow, P.
, Pontell, H. M., & Geis, G. (1985). Media criminals. Justice Quarterly, 2, 149-165.
30.
Jesilow, P.
, Pontell, H. M., & Geis, G. (1986). Physician immunity from prosecution and punishment for medical program fraud. In B. Groves & G. Newman (Eds.), Punishment and privilege (pp. 7-22). New York: Harrow and Heston.
31.
Jesilow, P.
, Pontell, H. M., & Geis, G. (1993). Prescription for profit. Irvine: University of California Press.
32.
Johnson, J.
(1994). Home alone: Tougher laws needed to protect housebound patients. American Medical News, 37(11), 1-4.
33.
Johnson, J.
(1996). Pace of federal health fraud prosecutions quickens. American Medical News, 39(41), 5-8.
34.
Johnson, J.
, Kennedy, T., & Jhuman, G. (1987). Gender differences in sentencing felony offenders. Federal Probation, 51(1), 66-76.
35.
Keenan, C. E.
, Brown, G. C., Pontell, H. N., & Geis, G. (1985). Medical students' attitudes on physician fraud and abuse in the Medicare and Medicaid programs. Journal of Medical Education, 60, 167-173.
36.
Killias, M.
, Aebi, M., & Ribeaud, D. (2000). Does community service rehabilitate better than short-term imprisonment?Howard Journal of Criminal Justice, 39, 40-57.
37.
Klemm, J. D.
(2000). Medicaid spending: A brief history. Health Care Financing Review, 22, 105-112.
38.
Liederbach, J.
, Cullen, F. T., Sundt, J., & Geis, G. (2001). Criminalization of physician violence: Social control in transformation. Justice Quarterly, 18, 141-170.
39.
Masters, B. A.
(1997, April 6). Investigators try to keep up with growing problems of health care fraud. Washington Post, p. BOI.
40.
Moyer, I.
(1992). The changing roles of women in the criminal justice system. Prospect Heights, IL: Waveland.
41.
National Association of Attorneys General
. (1993-2000). Medicaid fraud report. Washington, DC: National Association of Attorneys General.
42.
Nugent, D.
(1999). Providing solution for the growing trend toward healthcare. Health Management Technology, 20(18), 28.
43.
Palmer, B.
(1995, July 29). Prosecutor closes its case. Augusta Chronicle, p. A01.
44.
Payne, B. K.
(1995). Medicaid fraud: Actions, actors, and policy. Criminal Justice Policy Review, 7, 275-290.
45.
Payne, B. K.
(1998). Conceptualizing the impact of health care crimes on the poor. Free Inquiry in Creative Sociology, 26, 159-168.
46.
Payne, B. K.
(2000). Crime and elder abuse: An integrated perspective. Springfield, IL: Charles C Thomas.
47.
Payne, B. K.
, & Berg, B. L. (1997). Looking for fraud in all the wrong places. Police Journal, 70, 200-230.
48.
Payne, B. K.
, & Cikovic, R. (1995). An empirical examination of the characteristics, consequences, and causes of elder abuse in nursing homes. Journal of Elder Abuse and Neglect, 7(4), 61-74.
49.
Payne, B. K.
, & Dabney, D. A. (1997). Prescription fraud: Characteristics, consequences, and influences. Journal of Drug Issues, 27, 807-820.
50.
Pierro, L.
(2000). Federal act means tough going for home health agencies. Capital District Business Review, 27(36), 11B.
51.
Pontell, H. N.
, Jesilow, P., & Geis, G. (1982). Policing physicians. Social Problems, 30, 117-126.
52.
Pontell, H. N.
, Jesilow, P., & Geis, G. (1984). Practitioner fraud and abuse in medical benefit programs: Government regulation and professional white-collar crime. Law and Policy, 6, 405-424.
53.
Pontell, H. N.
, Jesilow, P., Geis, G., & O'Brien, M. J. (1985). A demographic portrait of physicians sanctioned by the federal government for fraud and abuse against Medicare and Medicaid. Medical Care, 23, 1028-1032.
54.
Provost, C.
, & Hughes, P. (2000). Medicaid: 35 years of service. Health Care Financing Review, 22, 141-174.
55.
Quinn, M. J.
, & Tomita, S. (1997). Elder abuse and neglect (2nd ed.). New York: Springer Publishing.
56.
Quinney, R.
(1970). The social reality of crime. Boston: Little, Brown.
57.
Rowland, D.
, & Garfield, R. (2000). Health care for the poor: Medicaid at 35. Health Care Financing Review, 22, 23-24.
58.
Ruhnka, J. C.
, Gac, E. J., & Boerstler, H. (2000). Qui tam claims. Journal of Health Politics, Policy, and Law, 25, 283-308.
59.
Saphir, A.
(1999, November 1). HCFA proposes PPS for home health. Modern Health Care, p. 10.
60.
Schoen, M. A.
, & Koenig, R. J. (1997). Home health care nursing. Medsurg Nursing, 6(4), 230-232.
61.
Schottle, A.
(1998). Providers rocked by cuts. Indianapolis Business Journal, 19(18), 15-18.
62.
Schwartz, H.
, & Jacobs, J. (1973). Qualitative sociology: method to the madness. New York: Free Press.
63.
Scott, J. S.
(2001). B-U-S-H does not spell relief from federal investigations. Healthcare Financial Management, 55(3), 26.
64.
Shepard, S.
(2000). Few home health players remain in once bustling sector. Business Journal, 18(5), 8.
65.
Smith, R. G.
(1999). Fraud and financial abuse of older people. Australian Institute of Criminology, 132, 1-6.
66.
Speaks, G.
(1995). Documenting inadequate care in the nursing home. Journal of Elder Abuse & Neglect, 8(3), 37-45.
67.
Taylor, J.
(1992). Medicaid fraud control. F.B.L. Law Enforcement Bulletin, 61(10), 17-20.
68.
Tillman, R.
, & Pontell, H. N. (1992). Is justice `collar-blind'?Criminology, 30, 547-574.
69.
Tonry, M.
(1999). Parochialism in the U.S. sentencing policy. Crime and Delinquency, 45, 48-65.
70.
Traub, S. H.
(1996). Battling employee crime: A review of corporate strategies and programs. Crime and Delinquency, 42, 244-256.
71.
Van Gigch, J.
(1978). Applied general systems theory. New York: Wiley.
72.
Vladeck, B.
(1995). Medicare, Medicaid, fraud, and abuse. Journal of the American Medical Association, 273(10), 766.
73.
Weisburd, D.
, Chayet, E. F., & Waring, E. J. (1990). White-collar crime and criminal careers. Crime and Delinquency, 36, 342-355.
74.
Wilson, P.
, Geis, G., Pontell, H. N., Jesilow, P., & O'Brien, M. J. (1985). Medical fraud and abuse: Australia, Canada, and the United States. International Journal of Comparative and Applied Criminal Justice, 9, 25-33.
75.
Witkin, G.
(1992, February 24). Health care fraud. US. News and World Report, 112, 34-43.
76.
Zahn, M.
(1997, March 4). Home aides have little supervision. Milwaukee Journal Sentinel, p. 7.
77.
Zambito, T.
, & Layton, M. J. (1999, October 3). Criminal caregivers. The Record. Northern NJ, p. AI+.
