Legislating Medicare Fraud
The Politics of Self-Regulation and the Creation of Professional Standards Review Organizations
Bibliographic Data
| ID | 12178283 |
|---|---|
| Authors | Brian Dolan (0000-0002-7935-8915, University of California, San Francisco, corresponding author), STEVEN BEITLER (University of California, San Francisco) |
| Year | 2022 |
| Volume | 34 |
| Issue | 4 |
| Pages | 475-504 |
| Publication date | 2022-09-01 |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Journal of Policy History (JOURNAL) |
| Journal identifiers | ISSN: 0898-0306 • E-ISSN: 1528-4190 |
| Publisher | Cambridge University Press (CUP) (PUBLISHER) |
| DOI | 10.1017/s0898030622000173 |
| OpenAlex | W4294307591 |
| Language | EN |
| References cited | 19 |
Not long after the 1966 enactment of Medicare and Medicaid, evidence emerged that unscrupulous physicians and health care organizations were gaming the system. Research over the past 50 years shows that around 10 percent of the federal government’s annual cost for these programs is attributed to fraudulent claims or abuses where hospitals and treatments have been overused for undue provider profit. This article examines early congressional attention to this problem and describes lawmakers’ attempts to find legislative solutions to it. It historicizes the dilemma of balancing the ideological limits of government regulation with cultural assumptions about professional self-regulation, focusing on a major 1972 law, the Professional Standards Review Organization (PSRO) Act. The law launched a 10-year career for PSROs, physician-staffed peer-review boards designed to identify and sanction efforts to overcharge Medicare. The article contextualizes multiple actors’ concerns over cost containment and the crisis of faith in medical authority that persisted following failures to control professional malfeasance
Business · Dilemma · Economics · Government (linguistics · Health care · Legislature · Management · Medicaid · Political science · Politics · Professional standards · Public relations · Undue influence · American History and Culture · Healthcare Policy and Management · Law · Occupational and Professional Licensing Regulation · Public Administration
The social transformation of American medicine
Profession of medicine
The Divided Welfare State
The Evolution of the PSRO Hospital Review System
A High-Wire Crusade
Causal Chains and Cost Shifting
Of Foxes and Hen Houses
Compulsory Health Insurance
Welfare Medicine in America
In the Public Interest
Regulatory Politics and American Medicine
| Highly cited | No |
|---|