Medical

WhiteCollar Crimes in SalesRelated Occupations and the Healthcare System

Can it be categorized? Can It Be Categorized?In a 1-2 page paper, choose one of the fraud categories discussed in Chapter 3 and 4. With the opportunity perspective in mind, describe the objectives which act as motivators for this crime. Chapter 3Chapter Three Summary To introduce students to the nature of crime in lower-class occupations, in this chapter, attention was given to the crimes occurring in the following systems: (1) employee theft in the retail system, (2) crimes in the entertainment service system, (3) fraud in the sales/ service system, and (4) insurance system. Several different varieties of employee theft in retail settings occur. Here are some examples: overcharging, shortchanging, coupon stuffing, credits for nonexistent returns, theft of production supplies and raw materials, embezzlement, over-ordering supplies, theft of credit card information, theft of goods, theft of money from the cash register, and sweetheart deals. Employee theft prevention strategies include (a) importation strategies, (b) internal strategies, (c) technological strategies, (d) (c) technological strategies, (d) organizational culture strategies, and (e) awareness strategies. In considering crimes in the restaurant industry, two broad categories can be highlighted: crimes by the restaurant against consumers and crimes by workers against the restaurant. The most common types of home repair fraud are believed to be roof repair, asphalt paving or driveway sealing fraud, house painting fraud, termite and pest control fraud, and tree pruning and landscaping fraud. Auto repair fraud includes billing for services not provided, unnecessary repairs, airbag fraud, and insurance fraud. Insurance crimes are rarely studied for two reasons: (1) They are hard to understand, and (2) people don’t typically know when they have been victimized by insurance crimes (Ericson & Doyle, 2006). Four different categories of insurance crimes by workers in the insurance system exist: (1) crimes by agents against the insurance company, (2) investment-focused crimes, (3) theft crimes against consumers, and (4) sales-directed crimes against consumers. Estimates suggest that insurance fraud collectively “raises the yearly cost of premiums by $ 300 for the average household” (FBI, 2010b). For individuals victimized by these offenses, the consequences of insurance crimes can be particularly devastating. Industry insiders attribute the insurance offenses to either rotten apple explanations or they engage in victim blaming (Ericson & Doyle, 2006). Ericson and Doyle (2006) point out that insurance crimes are institutionalized in the industry by the practices and strategies encouraged among insurance employees.ReferencesPayne, B. K. (2013). White-collar crime: The essentials. Thousand Oaks, CA: SAGEPublications. Chapter 4 Chapter Four Summary In general, categories of crimes committed by health care providers include fraud by doctors, fraud by pharmacists, drug use, unnecessary surgery, medication errors, sexual abuse, elder abuse, home health care fraud, and medical malpractice. Sutherland implied that doctors were unlikely to engage in white-collar crime, and as a result, Sutherland gave “only scant attention to doctors [and] maintained that physicians were probably more honest than other professionals” (Wilson et al., 1986). The most pervasive form of fraud committed by doctors entails the commission of Medicare and Medicaid fraud and abuse. Fraud refers to intentionally criminal behaviors by physicians, whereas abuse focuses on unintentional misuse of program funds. Several specific forms of fraud and abuse exist, including phantom treatment, substitute providers, upcoding, provision of unnecessary services, misrepresenting services, falsifying records, overcharging patients, unbundling, pingponging, ganging, kickbacks, co-pay waivers, and medical snowballing. Briefly, mental health professionals often bill for time, whereas other professionals bill for more complicated medical procedures. For investigators, it is much easier to prove “time violations” than “treatment violations.” Research shows that when females are accused of health care fraud, they tend to be accused along with other providers more than male offenders are (Payne, 1995). Explanations for fraud have focused on structural explanations, socialization factors, and enforcement dynamics. It is estimated that 7.5 million unnecessary surgeries and medical procedures occur annually, and 12,000 Americans are killed each year from these unnecessary surgeries (Black, 2005). At least six overlapping reasons help explain the pervasiveness of unnecessary surgeries: differing opinions, stigma, trust of health care, lack of trust of insurance companies, medicalized socialization, and conflict explanations. Many severe consequences may arise from unnecessary surgeries. Medication errors occur when health care providers deliver or prescribe the wrong medications to patients. Public Citizen has identified 16 varieties of misconduct by physicians. The group believes that variations in sanctions for violations across states can be attributed to differences in the way state medical boards sanction offenders. Eight types of prescription fraud are generic drug substitution, overbilling, double billing, billing for nonexistent prescriptions, short counting, mislabeling, delivery of a controlled substance, and illegally buying prescriptions. The following types of elder abuse can be seen as white-collar crimes: (1) elder physical abuse, (2) elder financial abuse, (3) elder neglect, (4) elder sexual abuse, and (5) failure to report crimes. Types of home health care fraud include providing unnecessary services, billing the system for services that were not provided to the client, overcharging, forgery, negative charting, substitute workers, double billing, and kickbacks. Medical malpractice refers to situations where health care providers perform negligent care and/ or injure patients. Patients can seek recourse by filing medical malpractice insurance claims against the provider’s insurance company or by filing a lawsuit against the provider.ReferencesPayne, B. K. (2013). White-collar crime: The essentials. Thousand Oaks, CA: SAGEPublications. 16/01/20205law

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