0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
ARTICLE |

Physicians Who Report Health Insurance Fraud and Their Practice Type: Health Maintenance Organization vs Fee-for-Service

Ira L. Salom, MD
Arch Intern Med. 1997;157(19):2270. doi:10.1001/archinte.1997.00440400122014.
Text Size: A A A
Published online

Farber et al1 found that physicians practicing in health maintenance organization (HMO) settings compared with those in fee-for-service settings were more likely to suggest reporting patients committing health insurance fraud in the scenarios presented in their questionnaire. In their discussion, the authors opine, Physicians who practice in staff-model HMOs... may feel more allegiance to third-party payers than physicians working primarily in a fee-for-service practice. In addition, physicians in an HMO setting may have a greater financial incentative to report insurance fraud, because their financial well-being is more directly related to the financial health of the third-party payers.

An alternative hypothesis explaining the difference is that fee-for-service physicians, in reporting patients committing insurance fraud, may directly affect the likelihood that their fees will be paid. That is, fee-forservice physicians may find that their decision is more directly related the financial health of their own practice, whereas HMO physicians are watching

Topics

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Jobs
brightcove.createExperiences();