The Experience and Enlightenment of Anti-Fraud in American Medical Services
Objective:The paper summarizes the experience of healthcare anti-fraud in the US,in order to provide experience and reference for constructing a systematic and efficient anti-fraud system and improving the efficiency of medical insurance fund utilization in China.Methods:Literature research and inductive generalization methods were used to summarize the experience and challenges of American healthcare anti-fraud system.Results:The healthcare anti-fraud system in the US was summarized from four aspects:legal and regulatory system,organizational system,whole-process supervision mechanism and public education.Conclusion:It is suggested to construct an anti-fraud system in China from establishing a law and regulation system for anti-fraud in medical services,strengthening top-level design and inter-ministerial cooperation,establishing a multi-level healthcare anti-fraud system,and enhancing public education on healthcare anti-fraud.
万方数据
维普
