Hansen and others differentiate between fraud under indemnity arrangements and fraud under managed care. Under managed care, it's more difficult. The system there has all the ingredients of a mess. For example, the HMO is not giving enough of the cap to the doctor. Here, the provider is trying to make up for lost income.
New schemes pop up all the time.
Clinical implications Sparrow says managed care abuse is more dangerous to patients. It was a purely financial crime. Undertreatment, though, is extremely dangerous and will kill patients. Another notoriously muddy area is ownership of physician practices by hospitals. Hospitals may own a physician's practice and pay a salary plus some sort of productivity bonus that includes revenue from hospital admissions.