Medical Professionals and Health Care Fraud: Do They Aid or Check Abuse?

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This paper examines the role of health care professionals in combating health care fraud. It is not overall clear whether the share of the health professionals help control abuse. Using data across U.S. states, our econometric results show that greater employment of nurses consistently reduced health fraud, whereas more physicians did not have a significant impact. Further, more urbanized states and states with a greater proportion of the elderly experienced greater health scams. Identity thefts facilitated health care fraud, whereas different dimensions of health insurance (including the share of the population with Medicare, managed care, and no insurance) and hospital occupancy rates did not matter.


This article was originally published as Rajeev K. Goel, 2020. "Medical professionals and health care fraud: Do they aid or check abuse?," Managerial and Decision Economics, John Wiley & Sons, Ltd., vol. 41(4), pages 520-528, June.