Date of Conferral
2013
Date of Award
2014
Degree
Doctor of Business Administration (D.B.A.)
School
Management
Advisor
Kenneth Gossett
Abstract
An estimated 3-10% of the $2 trillion spent annually on health care in the United States is lost to fraud. Improper payments undermine the integrity and financial sustainability of the Medicaid program and affect the ability of federal and state governments to provide health care services for individuals and families living at or below the poverty level. This study explored how health care leaders in the state of Arizona described factors contributing to the invisible nature of Medicaid fraud and abuse and necessary strategies for counteracting the business opportunities of Medicaid fraud and abuse. The institutional choice analytic framework grounded the study. Data were gathered from the review of documents and information received from 10 interviews with health care leaders responsible for the administration, delivery, and regulation of Medicaid services in Arizona. Collected data were coded to identify underlying themes. Key themes that emerged from the study included the need for health care leaders to use modern technologies to combat Medicaid fraud and abuse and concentrate and strengthen Medicaid fraud and abuse mitigation efforts at the state level. Study data might contribute to social change by identifying Medicaid fraud and abuse mitigation strategies that will protect the financial and structural integrity of the Medicaid program, ensuring Americans living at or below the poverty level have access to quality health care services.
