The preservation of health has been an instinctive necessity for mankind since the beginning of creation. A respectable individual with high social standing committing a crime while working is roughly called a white-collar crime. Upon closer examination, this term contains the following components: A person of high social position and respectability who commits a white-collar crime does so during his working life. A formal definition of white-collar crime was provided by Sutherland as “a crime committed by a person of high social status and respectability in the course of his occupation”.
Factors Contributing to a Criminal Mindset
Rational Choice Theory
After balancing the dangers and potential advantages, many people commit healthcare fraud. They frequently believe that the advantages outweigh the drawbacks, particularly in settings with lax regulatory oversight.
Self-control and Ethical Attitudes
Higher propensities for white-collar crime are correlated with poorer levels of self-control, according to research. People with weakened moral convictions may justify their dishonest behavior as appropriate in their situation.
Organizational Culture
In corporate settings, an environment that prioritizes profit over ethics can foster criminal behavior among employees who feel pressured to meet unrealistic targets.
Consequences of Healthcare Fraud
The U.S. loses billions annually due to healthcare fraud. Estimates suggest that between 10% to 25% of healthcare spending may be lost to fraudulent activities, significantly straining public resources and insurance systems. Fraudulent practices can lead to unnecessary medical procedures or dangerous treatments, resulting in severe health complications or even fatalities. For example, a cardiologist was sentenced to 20 years for performing unnecessary surgeries that defrauded Medicare while endangering patients. Widespread fraud undermines public trust in healthcare providers and institutions, leading to skepticism about the integrity of medical advice and treatment options.[1]Fraudulent practices may lead to patients undergoing unnecessary tests or surgeries solely for profit motives. This can result in serious health complications or irreversible outcomes for patients.
The Medical Mafia
The unholy triumvirate of the FDA (Food and Drug Administrator) and large pharmaceutical firms is referred to as the “Medical Mafia.” Over the last three decades, Nexus has made progress in comprehending its moral business practices. Here are a few instances of medical mafia and its consequences:
- The large pharmaceutical corporations will only be able to market medications for certain. Ailments since the Medical Mafia opposes generic drugs and demands strict patent regulations for medications in this field. As a result, the cost of the medication will be exorbitant.
- Its influence has spread beyond the pharmaceutical industry to include the food and beverage sectors.
- They would get a portion of the money or shares in the other businesses in this industry. For instance, the tobacco-producing company owns a portion of the cancer drug company.
- The Medical Mafia may use the guise of study to peddle their commercial propaganda.[2]
Organ trafficking as an instance of white-collar criminality
Organ trafficking is a complex form of white-collar crime that intertwines with broader issues of human rights violations and public health concerns. Organ trafficking is increasingly recognized as a serious form of transnational organized crime and can be classified under white-collar crime (WCC) due to its exploitative nature and the involvement of sophisticated networks. This illicit trade involves the illegal procurement and transplantation of human organs, often targeting vulnerable populations.
Organ traffickers primarily recruit individuals from impoverished backgrounds, often luring them with false promises of financial gain. Organ trafficking contravenes numerous international laws and ethical guidelines, including the U.N. Organ trafficking is specifically addressed under the Protocol to Prevent, Suppress, and Punish Trafficking in Persons.
Organ transplantation as a commercial enterprise, sometimes known as the organ trade, is governed under the Transplantation of Human Organs Act (THOA), 1994. The United Nations defines the illegal trade of human organs for financial gain, which can be classified as human trafficking when individuals are coerced or deceived into donating their organs. [3]
Biomedical waste
Any waste produced during medical procedures that could endanger the environment and public health if improperly managed is referred to as biomedical waste. Hazardous material exposure and contamination can result from improper biomedical waste disposal. Because biomedical waste management violations can cause extensive injury without resorting to physical violence, they can be classified as white-collar crimes.
To save money, some healthcare facilities may skimp on waste management procedures, putting financial gain ahead of patient safety and adherence to legal requirements. Communities and ecosystems may be negatively impacted by improper disposal, which poses major environmental risks. Healthcare personnel and the general public may be exposed to infections, disease transmission, and other health hazards as a result of poorly handled biomedical waste.[4]
Medical Identity Theft
Medical Identity Theft, a significant aspect of healthcare fraud involves medical identity theft, where impostors use another person’s identity to receive medical services. This not only defrauds insurers but also jeopardizes the victim’s health records and future care options. Fraud.
High-Profile Cases Notable cases include a psychiatrist who falsified diagnoses leading to over $20 million in fraudulent claims and a cardiologist who performed unnecessary procedures costing Medicare $29 million. These cases highlight both the financial motivations and the severe consequences for patients involved.[5]
Drug Abuse in Medicine
Drug abuse occurs when individuals use prescription medications in ways not intended by healthcare providers. Commonly abused drugs include opioid painkillers, anti-anxiety medications, and stimulants. The misuse can range from taking someone else’s medication to using prescribed drugs to achieve a high.
Prescription Drug Fraud includes forging prescriptions, overprescribing medications, or diverting drugs for illegal sale. It can involve both healthcare providers and patients manipulating the prescription process.[6]
Healthcare Insurance Fraud
A serious problem is healthcare insurance fraud, which is a dishonest tactic to get unapproved benefits from health insurance companies. This happens when medical personnel or organizations use unethical tactics to boost their earnings. Falsifying patient records, upcoding, unbundling, performing unnecessary services, and billing for services that were never rendered are examples of common techniques.
If found guilty of fraud, healthcare professionals risk having their licenses revoked and being prohibited from working in the medical industry. Fraud can be less common if customers are taught how to spot and report it. People are urged to carefully review their medical bills and to report any questionable activity. [7]
Public Trust Erosion
White-collar crimes like bribes, fraudulent billing, and illegal activities undermine this confidence. When patients discover that their medical professionals have acted unethically or illegally, they feel deceived and lose trust in the medical system. This loss of trust may have long-term effects, such as increased skepticism and an unwillingness to seek medical help. Unbundling involves billing separately for procedures that should be billed as part of a single comprehensive service, resulting in inflated charges. This practice misrepresents the services provided to maximize payments.
Genetics Testing Fraud highlighted schemes where individuals falsify testing records to inflate reimbursements from Medicare by manipulating service dates and paying illegal kickbacks to marketers. In Fraudulent Medicare Equipment Claims, providers submit false claims for durable medical equipment that was not provided or excessively billed for repairs and parts. Dental Care Fraud involves submitting claims without patient consent or misrepresenting the cost and necessity of services provided.[8]
Compromised Patient Safety
Patient safety in the medical field is directly impacted by white-collar crime. Patients are at risk when medical professionals utilize fake medications or recommend needless procedures out of financial interest. In a similar vein, unlicensed professionals without the required training may seriously injure patients by making inaccurate diagnoses or administering unsuitable therapies. Because inaccurate information may result in inappropriate treatment recommendations, falsifying medical records can also have serious consequences. In the end, these crimes may result in greater morbidity, worse health outcomes, or even death.
Ethical degradation
Honesty, integrity, and patient welfare are highly valued under the strict code of ethics that regulates the medical industry. White-collar crimes essentially violate these moral principles. In addition to harming specific patients, dishonest behavior by medical professionals harms the profession’s reputation.
Laws Governing White Collar Crime in the Medical Field
White-collar crime in the medical field has been addressed by several legislative frameworks. These regulations are intended to safeguard healthcare systems, protect patients, and hold criminals responsible. Under the BNS, medical negligence is specifically addressed in Section 106, which outlines the penalties for causing death through negligent acts. For causing death by negligence, the punishment can extend up to five years of imprisonment and a fine. If the negligent act is performed by a registered medical practitioner during medical procedures, the punishment is reduced to a maximum of two years.[9]
The Medical Council of India (MCI) Regulations
The National Medical Commission (NMC) has since taken the position of the Medical Council of India (MCI), which created a code of ethics for medical practitioners. These rules forbid actions like taking bribes, receiving unapproved medical care, and fabricating medical records, and they stress the value of upholding professional integrity. Discipline, such as the suspension or revocation of medical licenses, may follow violations of these ethical principles.
The Prevention of Corruption Act, 1988
Another crucial piece of legislation The Prevention of Corruption Act aids in the battle against white-collar crime in the medical industry. Corruption and bribery among public servants, particularly physicians and healthcare administrators employed by the government, are addressed by this statute. Offering or receiving bribes in return for medical services or referrals is illegal under this act, and anyone found guilty faces harsh punishments.
The 1940 Drug and Cosmetics Act
In India, the production, distribution, and sale of pharmaceuticals and medical equipment are governed by the Drugs and Cosmetics Act. It contains measures to stop the unlawful marketing of unapproved medications as well as the selling of fake or inferior medications. This law is especially important when pharmaceutical corporations are involved in unethical activities like paying doctors to prescribe particular medications or fabricating data from clinical trials.
The Clinical Establishments (Registration and Regulation) Act, 2010
By establishing guidelines for their operations and guaranteeing adherence to moral principles, the Clinical Establishments Act seeks to govern private healthcare institutions in India. Healthcare practitioners are obligated by this statute to keep correct records, follow recommended treatment guidelines, and refrain from fraud. Penalties for non-compliance may include fines and facility closures.
The Consumer Protection Act, 2019
Patients have a way to file complaints against healthcare providers through the Consumer Protection Act. Through this statute, patients can protest about service shortcomings, such as carelessness, unauthorized treatments, and fraudulent billing, against healthcare providers and facilities. Additionally, the act establishes consumer courts, which allow consumers to file a lawsuit and seek damages for injuries brought on by white-collar crimes in the medical field.
Duty of the judiciary in eradicating white-collar crime
In the fight against white-collar crime, which includes a variety of non-violent crimes usually carried out for financial gain, the judiciary is essential. Courts have increasingly adopted a stringent approach towards white-collar crimes, ensuring that offenders are prosecuted effectively. This shift is evident in high-profile cases involving corporate malfeasance, where the judiciary has expedited legal processes to address significant public interest issues. For the judiciary to effectively combat white-collar crime, robust legislative frameworks are crucial.
These laws must be clear, comprehensive, and adaptable to evolving criminal tactics. Continuous training for judges, prosecutors, and law enforcement agencies is vital to keep pace with emerging trends in white-collar crime. The judiciary holds a pivotal position in eradicating white-collar crime through rigorous enforcement, setting precedents, and advocating for specialized courts, it must also overcome significant challenges such as case complexity, delays in justice delivery, and resource limitations.
Strengthening legislative frameworks and enhancing judicial capacity will be essential for building a resilient legal system capable of addressing these sophisticated crimes effectively.[10]
Case Study of White-Collar Crime in the Healthcare Sector
The Vyapam Scam
The Vyapam scam, one of the most horrible cases, is also among the list of most well-known instances of white-collar criminality in India’s medical industry. In this scandal, students paid bribes to gain admissions using fraudulent techniques, and entrance examinations for Madhya Pradesh’s medical colleges were manipulated.
Numerous high-ranking officials and politicians were also implicated in the scheme, underscoring the systemic corruption in medical education. Although the Vyapam fraud led to many arrests and the conviction of several of the accused, it also revealed how susceptible the medical field is to unethical behavior.[11]
The Dr. Ketan Desai Case
Former Medical Council of India President Dr. Ketan Desai was detained in 2010 on suspicion of taking bribes to approve a medical school. The corruption in the regulatory agency in charge of monitoring medical practice and education in India was exposed by Desai’s case. Desai’s medical license was suspended as a result of the case, and the MCI underwent substantial revisions that eventually led to the creation of the National Medical Commission (NMC) to take its place.[12]
R G Kar Scam
Serious questions have been raised concerning the management of RG Kar Medical College and Hospital in Kolkata as a result of the ongoing investigation into financial irregularities, which has shown widespread corruption involving a network of people and practices. The Special Investigation Team (SIT) of the Kolkata Police has handed over the investigation to the Central Bureau of Investigation (CBI) in response to claims of financial impropriety that allegedly lasted more than three years. The terrible rape and murder of a hospital trainee doctor served as the initial impetus for this investigation, raising concerns about the management and operations of the hospital under former head Sandip Ghosh. [13]
According to reports, money intended for student activities was misappropriated, and students were forced to pay for hospital job placements. Ghosh and his colleagues are among the four people who have been taken into custody. Their involvement is detailed in a chargesheet issued by the CBI, which also contains allegations of criminal conspiracy and Prevention of Corruption Act offenses. A serious health hazard, improper management, and disposal of biomedical waste are being investigated by investigators. According to the allegations, Ghosh reportedly received commissions from medical equipment tenders that were rigged to favor particular companies.[14]
Impact of healthcare fraud on patients and society
Healthcare expenditures are inflated by fraudulent activities and eventually passed on to patients and insurance companies. The National Health Care Anti-Fraud Association estimates that healthcare fraud damages the US economy more than $68 billion annually. Patients may receive needless treatments or fake prescription drugs as a result of unethical behavior, which could hurt their health.
Patients’ faith in the medical system as a whole is damaged when they learn that their healthcare practitioners have committed fraud. People may be discouraged from getting essential medical care as a result of this breakdown in confidence. The ethical rules governing medical practice are broken by white-collar crimes. In addition to hurting specific patients, such behavior damages the standing of the medical community overall.
Financial Burden on Healthcare Systems
Healthcare systems bear a heavy financial burden from white-collar crime. For instance, fraudulent billing methods result in exorbitant medical expenses that are frequently transferred to consumers, insurance providers, and government initiatives. Healthcare systems are heavily burdened financially by white-collar crime. For instance, fraudulent billing methods result in exorbitant medical expenses that are frequently transferred to consumers, insurance providers, and government initiatives.
Compromised Patient Safety
Patient safety in the medical field is directly impacted by white-collar crime. Patients are at risk when medical professionals utilize fake medications or recommend needless procedures out of financial interest. In a similar vein, unlicensed professionals without the required training may seriously injure patients by making inaccurate diagnoses or administering unsuitable therapies.
Ethical Degradation
The rigorous code of ethics that governs the medical field places a strong emphasis on the value of honesty, integrity, and patient welfare. These moral precepts are fundamentally broken by white-collar crimes. In addition to hurting individual patients, dishonest behavior by medical practitioners damages the standing of the entire field. A culture of corruption and misconduct within the healthcare system may result from this ethical deterioration.
Impacting Economy and Tax Revenue
Beyond the immediate financial losses, white-collar crime has far-reaching effects. In the end, it exacerbates social inequality and economic instability by upsetting markets, lowering tax revenues, and eroding public confidence in economic institutions. To address these problems, the public and private sectors must work together to advance accountability and openness. Governments lose out on important tax revenue due to crimes like business misconduct and tax fraud. Vulnerable groups may be disproportionately affected by this loss if public services like healthcare and education receive less financing.
Governments may have to increase taxes to make up the difference in funding for vital programs like Medicare and Medicaid when fraudulent actions drive up healthcare expenses. Due to a vicious cycle of higher taxes and fewer services, taxpayers are forced to pay the price of fraud. According to the National Health Care Anti-Fraud Association (NHCAA), healthcare fraud may be responsible for between 3% and 10% of all medical expenses, or tens of billions of dollars lost annually.[15]
Investigating Healthcare Fraud
Planning, obtaining evidence, conducting interviews, analyzing data, and reporting are all important components in a comprehensive investigation into healthcare fraud. The use of specialized resources can greatly improve investigators’ capacity to detect fraudulent activity, thereby protecting public money and the integrity of healthcare. Fraud detection efforts can be improved by applying data mining techniques. This entails searching through huge datasets for irregularities or trends that point to fraudulent activity. Machine learning and sophisticated statistical techniques can be used to increase the precision of fraud detection.[16]
As detection techniques advance, fraudsters constantly modify their strategies. The emergence of cutting-edge technology like machine learning and artificial intelligence (AI) allows thieves to create intricate schemes that are more difficult to uncover. This includes using impersonation techniques and taking advantage of holes in digital systems. Numerous compliance requirements, which can differ greatly between federal and state regulations, must be negotiated by investigators. This includes abiding by the Anti-Kickback Statute (AKS) and the False Claims Act (FCA), which impose severe penalties for fraudulent activity.[17]
Whistleblowers in Combatting Healthcare Fraud
To prevent healthcare fraud, whistleblowers are crucial because they provide crucial data that reveals intricate schemes. Their efforts shield vulnerable groups from damaging practices while generating large cash recoveries for the government. Incentives and legal protections are essential for enabling these people to come forward without worrying about retaliation. Whistleblowers may bring “qui tam” cases on behalf of the government under the False Claims Act (FCA). In addition to encouraging people to report fraudulent activity, this legal framework enables them to get paid between 15% and 30% of the money the government recovers if the case is successful.[18]
Prevention Strategies and Suggestions
A multifaceted strategy including legal reforms, increased enforcement, and a renewed focus on ethical standards is needed to combat white-collar crime in the medical field.
Fortifying Legal Structures
It is necessary to have stronger legal frameworks that specifically handle the unique challenges posed by white-collar crime in the medical industry.
Enhancing Regulatory Oversight
Regulatory agencies such as the Central Drugs Standard Control Organisation (CDSCO) and the National Medical Commission (NMC) need to be given more authority, entailing regularly auditing healthcare facilities, making sure that only competent people are permitted to practice, and swiftly disciplining those who transgress ethical standards.
Promoting Ethical Education
Future physicians and healthcare professionals will be better prepared to withstand the temptations of white-collar crime if a strong sense of ethical duty is instilled from the beginning.
Ethical Implications
High ethical standards are expected of healthcare practitioners. Professional integrity is compromised by engaging in or ignoring fraudulent activity, which can have serious repercussions, such as losing one’s license and facing criminal charges. Healthcare fraud has legal repercussions in addition to ethical ones. Serious consequences, including incarceration and civil monetary fines, may follow violations.
Reporting cases of fraud is an ethical duty for healthcare workers. The dedication to patient safety and the integrity of the healthcare system form the basis of this obligation. The American Medical Association (AMA) stresses that doctors must deal with misbehavior since not reporting it might cause patients to continue suffering and erode public confidence in medical treatment.
In the interaction between a patient and a provider, trust is essential. This trust is damaged by healthcare fraud, which makes patients doubt the motives of their healthcare professionals. Patients’ health results may suffer if they are reluctant to follow treatment regimens or seek appropriate medical attention because they have doubts about the integrity of their healthcare providers.
Technological Solutions
Advanced technologies like artificial intelligence (AI), machine learning (ML), and data analytics are being used more and more in technological solutions for healthcare fraud detection to improve the efficacy and efficiency of fraud prevention initiatives. By looking for irregularities or odd trends in patient records that can point to fraudulent claims, artificial intelligence (AI) tools can identify indicators of medical identity theft. Accurate billing procedures and patient identity protection depend on this capability. [19]
Existing billing systems, claims processing software and electronic health records (EHRs) can all be easily integrated with fraud detection software. This interoperability improves fraud detection capabilities while increasing operational efficiency and minimizing disturbance to current procedures. As claims are received, AI algorithms keep an eye out for odd trends like duplicate claims or charging for unneeded procedures. By taking this proactive stance, healthcare providers can minimize financial losses by addressing any fraud before payments are made.
Comparative Analysis
A worldwide problem, healthcare fraud has varying effects on nations according to their healthcare systems, legal frameworks, and methods of enforcement. A comparison of healthcare fraud in different nations identifies both shared issues and distinctive strategies for detection and prevention. To efficiently detect fraud, higher-income nations typically use sophisticated statistical and data-mining tools.
For example, while lower-income nations could rely more on simple reporting methods, the United States uses advanced analytics to spot irregularities in claims data. Sharing experiences and best practices in the fight against healthcare fraud can be advantageous for nations. Global anti-fraud efforts could be more effective if international cooperation is strengthened. Fighting healthcare fraud necessitates a multifaceted strategy that incorporates strong legal frameworks from several jurisdictions. The EU prioritizes national and regional legislative actions as well as institutional collaboration.
The USA uses extensive legislation with heavy penalties to discourage fraudulent activities, whereas the UK uses specialized anti-fraud units and stringent anti-bribery laws. Every region keeps modifying its tactics to meet new obstacles in the fight against and enforcement of healthcare fraud. Coordination of efforts among member states to prevent healthcare fraud is a critical function of the European Healthcare Fraud and Corruption Network (EHFCN). Its main goals are to improve collaboration between healthcare institutions and exchange best practices.
Policy Recommendations
Strong compliance processes that incorporate internal monitoring, audits, and training should be put in place by healthcare organizations. The purpose of these programs ought to be to stop, identify, and address violations of ethical and legal requirements in the healthcare industry. To ensure compliance with legal obligations, the Patient Protection and Affordable Care Act requires Medicare and Medicaid providers to implement such programs.
Blockchain technology can offer unchangeable transaction records, and machine learning algorithms can spot irregularities in billing trends to stop fraud before it starts. To encourage more people to come forward without fear of reprisal, strengthen protections for those who expose fraud. This can entail amending existing legislation to provide whistleblowers with more protection and assistance. Raising awareness can encourage active participation from stakeholders in initiatives to combat fraud.
Impact on Patients
Patients’ financial security, health results, and trust in the healthcare system are all significantly and profoundly impacted by healthcare fraud. Consumers pay more out of cash and pay higher insurance premiums as a result of healthcare fraud. Fraudulent practices, including double billing or charging for needless procedures, raise the total cost of healthcare, which is subsequently transferred to patients in the form of higher deductibles and premiums.
By taking funds away from appropriate care, fraudulent activity might jeopardize patient safety. Fraud-related resource misallocation may result in patients receiving subpar care or experiencing delays in receiving essential medical services.
Limitations of the study
Numerous restrictions on the investigation of white-collar crime in the healthcare industry may make it more difficult to comprehend and effectively handle these illicit activities. Fear of legal ramifications or harm to one’s reputation prevents many white-collar crime incidents from being disclosed. International law is not included in this study; it only addresses the Indian legal system.
Conclusion
White-collar crimes in the medical field have been rising annually, according to the study’s final statement. If we wish to preserve the nation’s health, these need to be examined right now. Given that “health is the wealth,” this “wealth” needs to be appropriately preserved. Therefore, to restore the medical profession’s reputation as a respectable one, the Indian and state governments must cooperate to combat the growing threat of white-collar crimes in this field.
Furthermore, neither government should abdicate its duty to offer India’s inhabitants a robust, affordable, and efficient healthcare system. The governments must increase their funding for the healthcare sector to achieve this. Healthcare fraudulent activity remains a pervasive issue that undermines the integrity of medical practices and erodes public trust in healthcare systems. Continuous efforts from law enforcement and regulatory bodies are crucial in combating these fraudulent activities and ensuring accountability within the healthcare sector.
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[3] Karla Monterrosa-Yancey CAMS, Organ Trafficking: The Unseen Form of Human Trafficking, ACAMS Today (2018), https://www.acamstoday.org/organ-trafficking-the-unseen-form-of-human-trafficking/ (last visited Oct 28, 2024).
[4] Health Care Fraud — FBI, https://www.fbi.gov/investigate/white-collar-crime/health-care-fraud (last visited Oct 26, 2024).
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[7] Health Care Fraud — FBI, supra note 5.
[8] Busted: The top healthcare fraud schemes of Q3 2023, https://resources.cotiviti.com/fraud-waste-and-abuse/busted-the-top-healthcare-fraud-schemes-of-q3-2023 (last visited Oct 28, 2024).
[9] Medical Negligence Under BNS, Drishti Judiciary, https://www.drishtijudiciary.com/bharatiya-nyaya-sanhita-&-indian-penal-code/medical-negligence-under-bns (last visited Oct 28, 2024).
[10] Neena Hamid, Role of Judiciary in Containing White Collar Crime in India an Analytical Study, University (2021), https://shodhganga.inflibnet.ac.in:8443/jspui/handle/10603/473234 (last visited Oct 27, 2024).
[11] Aishwarya Agrawal, White Collar Crime in the Medical Profession, LawBhoomi (Sep. 3, 2024), https://lawbhoomi.com/white-collar-crime-in-the-medical-profession/ (last visited Oct 26, 2024).
[12] Id.
[13] Kolkata rape-murder case: ED raids RG Kar Hospital’s ex-principal Sandip Ghosh’s residence in alleged financial scam, Hindustan Times (2024), https://www.hindustantimes.com/india-news/kolkata-rape-murder-case-ed-raids-rg-kar-hospitals-ex-principal-sandip-ghoshs-residence-in-alleged-financial-scam-101725591067345.html (last visited Jan 2, 2025).
[14] Kolkata: CBI’s financial scam probe opens Pandora’s box of corruption and graft at RG Kar Hospital | Kolkata News – Times of India, https://timesofindia.indiatimes.com/city/kolkata/kolkata-cbis-financial-scam-probe-opens-pandoras-box-of-corruption-and-graft-at-rg-kar-hospital/articleshow/113173897.cms (last visited Jan 2, 2025).
[15] The Challenge of Health Care Fraud – NHCAA, https://www.nhcaa.org/tools-insights/about-health-care-fraud/the-challenge-of-health-care-fraud/ (last visited Jan 2, 2025).
[16] Nishamathi Kumaraswamy et al., Healthcare Fraud Data Mining Methods: A Look Back and Look Ahead, 19 Perspect. Health Inf. Manag. 1i (2022).
[17] Top Health Care Fraud Legal Challenges from NHCAA Training, https://www.caseiq.com/resources/health-care-fraud-legal-challenges/ (last visited Jan 2, 2025).
[18] Role of Whistleblowers in Healthcare Fraud Cases | Stanley L. Friedman, The Law Offices of Stanley L. Friedman, https://www.stanleyfriedmanlaw.com/resources/role-of-whistleblowers-in-healthcare-fraud/ (last visited Jan 2, 2025).
[19] Rajeev Sharma, AI Healthcare Fraud Detection: The Future of Healthcare Security, Markovate (Nov. 19, 2024), https://markovate.com/ai-healthcare-fraud-detection/ (last visited Jan 1, 2025).
Author: Ms. Ranjana Paul is a student of KIIT School of Law doing an LLM (master) in Business Law.
