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.
Key words
healthcare /
anti-fraud /
the US
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