Abstract: According to the National Coalition on Health Care (NCHC) (2009) inappropriate care, waste, and fraud is evident in the United States’ (U.S.) health care system. Conservative estimates of 3%, or $68 billion, of health care spending is lost because of fraud (National Health Care Anti-Fraud Association [NHCAA], 2009). The purpose of this quantitative descriptive study was to compare the Arizona AHCCCS program contractor executives’ perception of the level of adequacy of legislation and corporate compliance programs in deterring unethical behaviors to the perceptions of hospital executives. Using a validated survey from Van Crombrugghe’s (2002) study of health care executives in the hospital setting, this replicated study of health care executives in health plans was completed. Results indicated that there is a significant difference in the perceptions of between both executive types on fraud in hospitals and fraud legislation. One outcome of this study was the even though there were differences in perception on fraud, both types of executives perceived that compliance programs had significant impacts on deterring fraud. Eighty-six percent of the hospital executives and 99% of the payers indicated that corporate compliance programs were established to deter fraud. Recommendations include replicating this study with other health care executives to gain a broader perspective on perceptions.
Keywords: Fraud legislation,Health care executives, Health care fraud