Abstract

GOMEZ PINEDA, Floro Hermes. Fraud and distortion of managed health care: the case of Colombia. Rev. repub. [online]. 2021, n.31, pp.55-70.  Epub Feb 02, 2022. ISSN 1909-4450.  https://doi.org/10.21017/rev.repub.2021.v31.a107.

The thesis why in Colombia is common to both some insurers as some operators, covered in managed health care, use cunning, deceit or machination in providing health care arises. For this reason, it is necessary to elucidate the fundamentals of practice instituting fraud and cost control through its various operating mechanisms: secret operations to deny services, use skillful actions to invent bureaucratic procedures and denature managed healthcare, mechanisms that are viewed from the concept of fraud and are understood from two different areas: the environment conducive to immorality and the historical understanding of the phenomenon.

Keywords : fraud; health services administration; cost control; patient harm; health facility administration.

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