Resumo

Their study focuses on delineating, detecting occurrences, and comprehending the elements influencing health insurance fraud (HIF). The research provides an in-depth examination of fraud in the healthcare sector, listing six interpretations, 22 manifestations, and 47 determining elements associated with health insurance fraud. Their work is pioneering in mapping out the intricacies and subtleties of healthcare fraud. Our study seeks to broaden the understanding provided by Villegas-Ortega et al. (2021). by specifically emphasizing on frauds within public healthcare policies

The goal of our research is to conduct a systematic review to identify the types of fraud, detection and prevention methods, and the impacts of fraud within the public healthcare sector.

Few crimes involve as many different organizations working to combat it as fraud does. Law enforcement agencies, various government departments and sections, the Serious Fraud Office (SFO), specialized private investigation firms, multiple entities within local authorities, and private companies are among the most notable participants in this field Button (2011). Healthcare fraud extends beyond borders and is a global concern. Although much of the available literature focuses on fraudulent activities within the public sector related to ’welfare,’ (Banerjee et al., 2008; Brooks et al.,

The objective of this review is to outline and identify the causes or factors that influence and the consequences or occurrences related to fraud in the public health sector. In doing so, we aim to answer the following questions: Question 1: What constitutes fraud in public healthcare? and Question 2: How does fraud in public health policies manifest themselves? The resulting aim to pave the way for more effective interventions to prevent, detect, and respond to fraudulent activities.

This study offers a comprehensive summary of fraud in the public healthcare sector and corporate domains, highlighting its complexity and negative effects on financial stability and social well-being. It stresses the importanceof identifying and preventing fraudulent activities, based on broad research that emphasizes the and global concern of healthcare fraud. A systematic literature review spanning nearly three decades was conducted, specifically targeting fraud in public healthcare.

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